RESUMO
PURPOSE: To assess retrospectively the success of percutaneous transluminal angioplasty (PTA) in treating innominate artery stenoses and occlusion in a large series of patients with long-term follow-up results. METHODS: In symptomatic patients with high degree (> 60%) stenosis, innominate artery PTA was performed. Long-term follow-up was undertaken by blood pressure measurements on both arms as well as subclavian, right common carotid and right vertebral duplex scan. RESULTS: Between 1981 and 1999, primary success rate of 89 innominate artery PTA (84 stenoses, 5 occlusions) was 96.4%. Complications included 1 left occipital lobe infarction (1.5%), 2 puncture-site thrombosis (2.9%), and 4 TIA (5.8%). Two patients with restenosis were successfully treated with rePTA. Cumulative primary patency was 98 +/- 2% at 6 months, 93 +/- 4% at 16 to 117 months, secondary patency was 100% at 6 months, 98 +/- 2% at 12 to 117 months; 61% of the patients became symptomless, 32% improved, 7% showed no improvement. CONCLUSION: Angioplasty of the innominate artery has been proven to be safe and effective on a large series of patients. For innominate artery stenosis and short occlusion, PTA should be the first treatment of choice.
Assuntos
Angioplastia , Braço/irrigação sanguínea , Arteriosclerose/cirurgia , Tronco Braquiocefálico/cirurgia , Adulto , Idoso , Angiografia , Angioplastia/efeitos adversos , Angioplastia/métodos , Arteriosclerose/diagnóstico por imagem , Tronco Braquiocefálico/diagnóstico por imagem , Infarto Cerebral/etiologia , Feminino , Humanos , Claudicação Intermitente/cirurgia , Ataque Isquêmico Transitório/etiologia , Masculino , Pessoa de Meia-Idade , Lobo Occipital/irrigação sanguínea , Recidiva , Reoperação , Estudos Retrospectivos , Trombose/etiologia , Resultado do TratamentoRESUMO
Over a period of 12 years, percutaneous transluminal angioplasty was used to dilate 227 subclavian obliterations (216 stenoses, 11 occlusions) in 208 patients. Immediate success rate was 96%. 152 dilated arteries long-term patency are known. The average follow-up time was 32 months (1-120 months). 14 restenosis occurred. In 7 of the 14 patients redilation were performed. Complication: 3 puncture site thrombosis, 1 haematoma, 4 transient confusion occurred. In 2 patients shoulder pain developed with unknown origin, and last for a few weeks. There were no irreversible neurologic deficit. Percutaneous transluminal angioplasty of subclavian artery stenoses should be the procedure of choice in symptomatic patients.
Assuntos
Angioplastia com Balão , Arteriopatias Oclusivas/terapia , Artéria Subclávia/diagnóstico por imagem , Síndrome do Roubo Subclávio/terapia , Adulto , Idoso , Angiografia , Braço/irrigação sanguínea , Braço/diagnóstico por imagem , Arteriopatias Oclusivas/diagnóstico por imagem , Feminino , Humanos , Isquemia/diagnóstico por imagem , Isquemia/terapia , Masculino , Pessoa de Meia-Idade , Síndrome do Roubo Subclávio/diagnóstico por imagem , Arterite de Takayasu/diagnóstico por imagem , Arterite de Takayasu/terapiaRESUMO
The authors present a case of moyamoya disease associated with subclavian steal syndrome. They could not find any report in literature about the combination of these syndromes. The Doppler, MR, and angiographic findings as well as the clinical importance of subclavian steal and moyamoya syndromes are briefly summarized.
Assuntos
Doença de Moyamoya/complicações , Síndrome do Roubo Subclávio/complicações , Adulto , Angioplastia , Angiografia Cerebral , Diabetes Mellitus Tipo 1/complicações , Feminino , Humanos , Imageamento por Ressonância Magnética , Doença de Moyamoya/diagnóstico , Doença de Moyamoya/diagnóstico por imagem , Artéria Subclávia/cirurgia , Síndrome do Roubo Subclávio/diagnóstico , Síndrome do Roubo Subclávio/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Ultrassonografia Doppler TranscranianaRESUMO
In the reported case, coarctation of the aortic arch (Coa) was the cause of hypertonia. Coa diminishes the expected lifetime, and operative treatment is required. PTA is contradictory in the treatment of coarctation. In the reported case coarctation was located on the aortic arch, and because of the risk of the operation PTA was performed. The dilatation was successful, hypertension resolved, and there was no significant difference in the blood pressure on the extremities. 16 months after the dilatation the patient is symptomless. The result of this case indicates that PTA of the Coa of the aorta is feasible. More experience is needed to establish its role.