Percutaneous transluminal angioplasty of the subclavian arteries: long-term results in 52 patients.

We studied the long-term results of percutaneous transluminal angioplasty of the subclavian artery in treating stenosis (43 patients) or occlusion (nine patients). In all 52 patients, the blood pressure before treatment in the arm on the involved side was at least 30 mm Hg lower than that in the opposite arm. Thirty-nine patients (75%) had symptoms of vertebrobasilar insufficiency (dizziness, blurred vision, ataxia). Angioplasty was successful in 40 (93%) of 43 patients with stenosis and in five (56%) of nine patients with occlusion. In the successfully treated patients, follow-up angiograms showed absence of narrowing greater than 30% stenosis, and the blood pressure in the treated arm equaled that in the opposite arm. The patients were followed up for 6-48 months (mean, 29 months). During this time, the blood pressure in the treated arm remained normal in 41 (91%) of 45 patients. The symptoms of vertebrobasilar insufficiency subsided in 28 (72%) of 39 patients. These results suggest that percutaneous transluminal angioplasty is useful for treating subclavian artery stenosis or occlusion.

[Selective ambulatory transbrachial intra-arterial DSA of supra-aortic arteries with atypical origins]. / Selektive ambulante transbrachiale intraarterielle DSA der supraaortalen Arterien bei atypischen Abgängen der supraaortalen Arterien.

We have already published the technique of SATISDA of supra-aortic arteries using the Tomac 1-3 catheter. In this group of 500 patients, selective demonstration of individual supra-aortic arteries was unsuccessful in 77 patients (15.4%). Demonstration was unsuccessful of three left vertebral arteries (0.6%), 45 left carotid arteries (9%), right carotid in nine (1.8%) and right vertebral artery in 20 (4%). In most cases the failure was due to an atypical origin of the vessel. To increase the success rate we used a 4-French newly developed straight Tomac 4-5 catheter. Using a combination of both catheters, selective demonstration of the left carotid was successful in 41 patients (91.1%), the right carotid in 8 (88.8%) and the right vertebral in 18 (90%). In three patients, a left-sided catheterisation had to be performed to demonstrate the left vertebral artery. Complications consisted of 17 local haematomas (3%) and reversible spasm at the puncture site in one patient (0.2%).

[Selective ambulant transbrachial intra-arterial DSA of the supra-aortic arteries]. / Selektive ambulante transbrachiale intraarterielle DSA der supraaortalen Arterien.

The improved Tomac 1, 2 and 3 (T1, T2, T3) catheters for selective transbrachial intra-arterial DSA of supra-aortic arteries are described. 1,100 patients have been examined. Using the T1 or T2 catheters, selective demonstration of the left subclavian artery was possible in 98% of 880 patients and the left common carotid artery in 88%. Semiselective demonstration of the right cerebral vessels was successful in all patients. In 220 patients a combination of T1, T2 and T3 catheters was used, resulting in 100% demonstration of the left subclavian artery, 97% demonstration of the right carotid artery, 88% demonstration of the right vertebral artery and 95% demonstration of the left common carotid artery. The only serious complication was thrombosis at the site of puncture in 0.18% of patients. These results have encouraged us to use the new catheters for outpatients.

New catheter technique for transcubital intraarterial DSA of the aortic arch and the supraaortic vessels.

A new catheter for the intraarterial DSA of the aortic arch and the selective demonstration of the supraaortal branches is presented. The catheter is introduced through the right cubital artery (introduction is also possible through the brachial or the axillary artery), which is favorable for performing the examination on ambulant patients. A technique for performing angiography in the region of the aortic arch and one for the selective demonstration of all supraaortic vessels, without the need to change catheters, is described. The authors have used the new technique on 200 patients who were referred for a DSA examination as a result of suspected CVI. Good selective demonstration of all the supraaortic vessels was achieved in 155 patients (77.5%). In the remaining patients we had to do without selective demonstration of the subclavian artery or the carotid artery. Even in these cases, the innominate artery and its branches could be selectively demonstrated. The advantages of the new catheter technique are clear in performing intraarterial DSA on ambulant patients, and by using only one catheter for demonstration of the aortic arch and selective demonstration of all the supraaortic arteries in the extra- and intracranial region. The advantages of transcubital puncture and also its complications are dealt with.

[The role of intravenous digital subtraction angiography in the detection of the cause of cerebral ischemia]. / Uloga intravenske digitalne suptrakcijske angiografije u otkrivanju uzroka ishemije mozga.

A comparative analysis of two angiography methods applied in two unrelated groups of patients with brain ischemia symptoms is described. The first group of 452 patients suffering from extracranial cerebral artery disease was analyzed by an intravenous digital subtraction angiography (DSA); the second group of 500 patients was subjected to a conventional aortic arch angiography. Research was based on comparative analysis of angiograms as per type and location of morbid changes. In the area of common carotid artery and internal carotid artery the stenosis was considerably more frequently detected by the conventional angiography than by the intravenous DSA, i.e. in 105 (20.0%) as compared to 40 (8.8%) patients, respectively. Similar difference is indicated in a total number of morbid changes in these arteries detected in 248 patients (49.6%) by aortic arch angiography and in 154 (34.1%) patients by intravenous DSA. The dissimilarity is noticed with minor atherosclerotic changes, while medium and major stenoses are detected with equal frequency by both methods. The intravenous DSA more often indicated flexion of carotid artery, and considerably more often the vertebral artery flexion as found in 53 (11.7%) patients analyzed by intravenous DSA compared to 33 (6.6%) patients analyzed by conventional angiography. Advantage of intravenous DSA is less complications and ambulatory performance. The conventional angiography better indicates morbid changes in common carotid artery bifurcation and vertebral artery origin.