Treatment of atherosclerotic lesion of the first segment of subclavian artery

Close metadata

Recommended articles:

Combined extravasal compression of the right subclavian artery caused by stellate ganglion schwannoma and additional rudimentary cervical rib. Clinical case and literature review. Burdenko's Journal of Neurosurgery. 2025;(2):72-82

Severe subclavian artery lesion is an important medical and social problem worsening the quality of life and leading to dire consequences. Vertebrobasilar insufficiency is the main syndrome of lesion of the first segment of subclavian artery. About 20% of all ischemic strokes occur in vertebrobasilar basin. At present, surgical treatment of asymptomatic patients with severe lesion of the 1^st segment of subclavian artery is still debatable. Open surgery is optimal for occlusion of this vascular segment. Carotid-subclavian transposition is a preferable option with favorable in-hospital and long-term results. However, carotid-subclavian bypass is an equivalent alternative in case of difficult transposition following anatomical and topographic features of vascular architectonics. Endovascular treatment is preferable for isolated subclavian artery stenosis and should certainly include stenting.

Keywords:

subclavian artery

vertebrobasilar insufficiency

carotid-subclavian transposition

carotid-subclavian bypass

transluminal balloon angioplasty

subclavian artery stenting

Authors:

Beloyartsev D.F.

Vishnevsky National Medical Research Center of Surgery;
Russian Medical Academy of Continuous Professional Education

ORCID: 0000-0002-7808-3454

Adyrkhaev Z.A.

Vishnevsky National Medical Research Center of Surgery;
Russian Medical Academy of Continuous Professional Education

ORCID: 0000-0001-6013-4017

Fagamov R.R.

Vishnevsky National Medical Research Center of Surgery

ORCID: 0000-0002-3149-7190

Received:

07.04.2023

Accepted:

04.09.2023

List of references:

Pokrovskii AV. Klinicheskaya angiologiya: rukovodstvo: v 2 tomah. T. 1. M.: Medicina; 2004. (In Russ.).
Shadman R, Criqui MH, Bundens WP, Fronek A, Denenberg JO, Gamst AC, McDermott MM. Subclavian artery stenosis: prevalence, risk factors, and association with cardiovascular diseases. JACC: Journal of the American College of Cardiology. 2004;44(3):618-623. https://doi.org/10.1016/j.jacc.2004.04.044
English JA, Carell ES, Guidera SA, Tripp HF. Angiographic prevalence and clinical predictors of left subclavian stenosis in patients undergoing diagnostic cardiac catheterization. Catheterization and Cardiovascular Interventions. 2001;54(1):8-11. https://doi.org/10.1002/ccd.1230
Markus HS, van der Worp HB, Rothwell PM. Posterior circulation ischaemic stroke and transient ischaemic attack: diagnosis, investigation, and secondary prevention. Lancet Neurology. 2013;12(10):989-998. https://doi.org/10.1016/S1474-4422(13)70211-4
Flossmann E, Rothwell PM. Prognosis of vertebrobasilar transient ischaemic attack and minor stroke. Brain. 2003;126(Pt 9):1940-1954. https://doi.org/10.1093/brain/awg197
Pokrovskii AV, Beloyartsev DF. Otdalennye rezul’taty operatsii podklyuchichno-sonnoi transpozitsii. Angiologiya i sosudistaya khirurgiya. 2002;8(2):84-89. (In Russ.).
Gutierrez GR, Mahrer P, Aharonian V, Mansukhani P, Bruss J. Prevalence of subclavian artery stenosis in patients with peripheral vascular disease. Angiology. 2001;52(3):189-194. https://doi.org/10.1177/000331970105200305
Osborn LA, Vernon SM, Reynolds B, Timm TC, Allen K. Screening for subclavian artery stenosis in patients who are candidates for coronary bypass surgery. Catheterization and Cardiovascular Interventions. 2002;56(2):162-165. https://doi.org/10.1002/ccd.10198
Lobato EB, Kern KB, Bauder-Heit J, Hughes L, Sulek CA. Incidence of coronary-subclavian steal syndrome in patients undergoing noncardiac surgery. Journal of Cardiothoracic and Vascular Anesthesia. 2001;15(6):689-692. https://doi.org/10.1053/jcan.2001.28309
Kazanchjan PO, Skrylev SI, Matjushov JuS, Rudakova TV. Hirurgicheskoe lechenie okkljuzirujushhih porazhenij podkljuchichnyh arterij. Hirurgija. 1994;7:8-11. (In Russ.).
Naylor R, Rantner B, Ancetti S, de Borst GJ, De Carlo M, Halliday A, Kakkos SK, Markus HS, McCabe DJH, Sillesen H, van den Berg JC, Vega de Ceniga M, Venermo MA, Vermassen FEG, Esvs Guidelines Committee, Antoniou GA, Bastos Goncalves F, Bjorck M, Chakfe N, Coscas R, Dias NV, Dick F, Hinchliffe RJ, Kolh P, Koncar IB, Lindholt JS, Mees BME, Resch TA, Trimarchi S, Tulamo R, Twine CP, Wanhainen A, Document Reviewers, Bellmunt-Montoya S, Bulbulia R, Darling RC 3rd, Eckstein HH, Giannoukas A, Koelemay MJW, Lindström D, Schermerhorn M, Stone DH. Editor’s Choice — European Society for Vascular Surgery (ESVS) 2023 Clinical Practice Guidelines on the Management of Atherosclerotic Carotid and Vertebral Artery Disease. European Journal of Vascular and Endovascular Surgery. 2023;65(1):7-111. https://doi.org/10.1016/j.ejvs.2022.04.011
AbuRahma AF, Avgerinos ED, Chang RW, Darling RC 3rd, Duncan AA, Forbes TL, Malas MB, Murad MH, Perler BA, Powell RJ, Rockman CB, Zhou W. Society for Vascular Surgery clinical practice guidelines for management of extracranial cerebrovascular disease. Journal of Vascular Surgery. 2022;75(1S):4-22. https://doi.org/10.1016/j.jvs.2021.04.073
Natsional’nye rekomendatsii po vedeniyu patsientov s zabolevaniyami brakhiotsefal’nykh arterii. Angiologiya i sosudistaya khirurgiya. 2013;19(2):4-68. (In Russ.).
Kazanchyan PO, Popov VA, Stenyaev YuA, Debely YuV, Rudakova TV, Valikov EA, Larkov RN, Derzanov AV. Otdalennye rezul’taty khirurgicheskogo lecheniya bol’nykh s okklyuziei I segmenta podklyuchichnykh arterii. Angiologiya i sosudistaya khirurgiya. 2002;8(4):94-101. (In Russ.).
Sandmann W, Grabitz K, Pfieffer T, Ritter R. Extrathoracic reconstruction of aortic arch branches. In: Long-term results of arterial interventions. Branchereau A., Jacobs M., eds. NY: Futura Publishing Company, Inc; 1997;89-96.
Schillinger M, Haumer M, Schillinger S, Mlekusch W, Ahmadi R, Minar E. Outcome of conservative versus interventional treatment of subclavian artery stenosis. Journal of Endovascular Therapy. 2002;9(2):139-146. https://doi.org/10.1177/152660280200900201
Criado FJ. Extrathoracic management of aortic arch syndrome. British Journal of Surgery. 1982;69:45-51. https://doi.org/10.1002/bjs.1800691316
Edwards WH Jr, Tapper SS, Edwards WH Sr, Mulherin JL Jr, Martin RS 3rd, Jenkins JM. Subclavian revascularization. A quarter century experience. Annals of Surgery. 1994;219(6):673-678. https://doi.org/10.1097/00000658-199406000-00010
Vitti MJ, Thompson BW, Read RC, Gagne PJ, Barone GW, Barnes RW, Eidt JF. Carotid-subclavian bypass: a twenty-two-year experience. Journal of Vascular Surgery. 1994;20(3):411-418. https://doi.org/10.1016/0741-5214(94)90140-6
Schardey HM, Meyer G, Rau HG, Gradl G, Jauch KW, Lauterjung L. Subclavian carotid transposition: an analysis of a clinical series and a review of the literature. European Journal of Vascular and Endovascular Surgery. 1996;12(4):431-436. https://doi.org/10.1016/s1078-5884(96)80009-8
Takach TJ, Duncan JM, Livesay JJ, Ott DA, Cervera RD, Cooley DA. Contemporary relevancy of carotid-subclavian bypass defined by an experience spanning five decades. Annals of Vascular Surgery. 2011;25(7):895-901. https://doi.org/10.1016/j.avsg.2011.06.003
Duran M, Grotemeyer D, Danch MA, Grabitz K, Schelzig H, Sagban TA. Subclavian carotid transposition: immediate and long-term outcomes of 126 surgical reconstructions. Annals of Vascular Surgery. 2015;29(3):397-403. https://doi.org/10.1016/j.avsg.2014.09.030
Cinà CS, Safar HA, Laganà A, Arena G, Clase CM. Subclavian carotid transposition and bypass grafting: consecutive cohort study and systematic review. Journal of Vascular Surgery. 2002;35(3):422-429. https://doi.org/10.1067/mva.2002.120035
Kazantsev AN, Chernykh KP, Zarkua NE, Leader RYu, Bagdavadze GSh, Kalinin EYu, Chikin AE, Linets YuP. Vybor optimal’nogo metoda revaskulyarizatsii pri polnom stil-sindrome. Kardiologiya i serdechno-sosudistaya khirurgiya. 2021;14(2):195-201. (In Russ.). https://doi.org/10.17116/kardio202114021195
Iared W, Mourão JE, Puchnick A, Soma F, Shigueoka DC. Angioplasty versus stenting for subclavian artery stenosis. Cochrane Database and Systematic Reviews. 2022;2(2):CD008461. https://doi.org/10.1002/14651858.CD008461.pub4
Chatterjee S, Nerella N, Chakravarty S, Shani J. Angioplasty alone versus angioplasty and stenting for subclavian artery stenosis — a systematic review and meta-analysis. American Journal of Therapeutics. 2013;20(5):520-523. https://doi.org/10.1097/MJT.0b013e31822831d8
Schillinger M, Haumer M, Schillinger S, Ahmadi R, Minar E. Risk stratification for subclavian artery angioplasty: is there an increased rate of restenosis after stent implantation? Journal of Endovascular Therapy. 2001;8(6):550-557. https://doi.org/10.1177/152660280100800603
Bates MC, Broce M, Lavigne PS, Stone P. Subclavian artery stenting: factors influencing long-term outcome. Catheterization and Cardiovascular Interventions. 2004;61(1):5-11. https://doi.org/10.1002/ccd.10711
De Vries JP, Jager LC, Van den Berg JC, Overtoom TT, Ackerstaff RG, Van de Pavoordt ED, Moll FL. Durability of percutaneous transluminal angioplasty for obstructive lesions of proximal subclavian artery: long-term results. Journal of Vascular Surgery. 2005;41(1):19-23. https://doi.org/10.1016/j.jvs.2004.09.030
Henry M, Henry I, Polydorou A, Polydorou A, Hugel M. Percutaneous transluminal angioplasty of the subclavian arteries. International Angiology. 2007;26(4):324-340.
Mousa AY, AbuRahma AF, Bozzay J, Broce M, Barsoum E, Bates M. Anatomic and clinical predictors of reintervention after subclavian artery stenting. Journal of Vascular Surgery. 2015;62(1):106-114. https://doi.org/10.1016/j.jvs.2015.01.055
Soga Y, Tomoi Y, Fujihara M, Okazaki S, Yamauchi Y, Shintani Y, Suzuki K; SCALLOP Investigators. Perioperative and Long-term Outcomes of Endovascular Treatment for Subclavian Artery Disease From a Large Multicenter Registry. Journal of Endovascular Therapy. 2015;22(4):626-633. https://doi.org/10.1177/1526602815590579
Karpenko AA, Ignatenko PV, Starodubtsev VB, Gostev AA. Jendovaskuljarnoe lechenie steno-okkljuzionnyh porazhenij podkljuchichnyh arterij. Patologija krovoobrashhenija i kardiohirurgija. 2015;19(3):87-93. (In Russ.).
Brountzos EN, Petersen B, Binkert C, Panagiotou I, Kaufman JA. Primary stenting of subclavian and innominate artery occlusive disease: a single center’s experience. CardioVascular and Interventional Radiology. 2004;27(6):616-623. https://doi.org/10.1007/s00270-004-0218-y
Przewlocki T, Kablak-Ziembicka A, Pieniazek P, Musialek P, Kadzielski A, Zalewski J, Kozanecki A, Tracz W. Determinants of immediate and long-term results of subclavian and innominate artery angioplasty. Catheterization and Cardiovascular Interventions. 2006;67(4):519-526. https://doi.org/10.1002/ccd.20695
Patel SN, White CJ, Collins TJ, Daniel GA, Jenkins JS, Reilly JP, Morris RF, Ramee SR. Catheter-based treatment of the subclavian and innominate arteries. Catheterization and Cardiovascular Interventions. 2008;71(7):963-968. https://doi.org/10.1002/ccd.21549
Sixt S, Rastan A, Schwarzwälder U, Bürgelin K, Noory E, Schwarz T, Beschorner U, Frank U, Müller C, Hauk M, Leppanen O, Hauswald K, Brantner R, Nazary T, Neumann FJ, Zeller T. Results after balloon angioplasty or stenting of atherosclerotic subclavian artery obstruction. Catheterization and Cardiovascular Interventions. 2009;73(3):395-403. https://doi.org/10.1002/ccd.21836
Bradaric C, Kuhs K, Groha P, Dommasch M, Langwieser N, Haller B, Ott I, Fusaro M, Theiss W, von Beckerath N, Kastrati A, Laugwitz KL, Ibrahim T. Endovascular therapy for steno-occlusive subclavian and innominate artery disease. Circulation Journal. 2015;79(3):537-543. https://doi.org/10.1253/circj.CJ-14-0855
Van de Weijer MA, Vonken EJ, de Vries JP, Moll FL, Vos JA, de Borst GJ. Technical and Clinical Success and Long-Term Durability of Endovascular Treatment for Atherosclerotic Aortic Arch Branch Origin Obstruction: Evaluation of 144 Procedures. European Journal of Vascular and Endovascular Surgery. 2015;50(1):13-20. https://doi.org/10.1016/j.ejvs.2015.03.058
Modarai B, Ali T, Dourado R, Reidy JF, Taylor PR, Burnand KG. Comparison of extra-anatomic bypass grafting with angioplasty for atherosclerotic disease of the supra-aortic trunks. British Journal of Surgery. 2004;91(11):1453-1457. https://doi.org/10.1002/bjs.4751
AbuRahma AF, Bates MC, Stone PA, Dyer B, Armistead L, Scott Dean L, Scott Lavigne P. Angioplasty and stenting versus carotid-subclavian bypass for the treatment of isolated subclavian artery disease. Journal of Endovascular Therapy. 2007;14(5):698-704. https://doi.org/10.1177/152660280701400515
Palchik E, Bakken AM, Wolford HY, Saad WE, Davies MG. Subclavian artery revascularization: an outcome analysis based on mode of therapy and presenting symptoms. Annals of Vascular Surgery. 2008;22(1):70-78. https://doi.org/10.1016/j.avsg.2007.07.020
Linni K, Ugurluoglu A, Mader N, Hitzl W, Magometschnigg H, Hölzenbein TJ. Endovascular management versus surgery for proximal subclavian artery lesions. Annals of Vascular Surgery. 2008;22(6):769-775. https://doi.org/10.1016/j.avsg.2008.08.001
Song L, Zhang J, Li J, Gu Y, Yu H, Chen B, Guo L, Wang Z. Endovascular stenting vs. extrathoracic surgical bypass for symptomatic subclavian steal syndrome. Journal of Endovascular Therapy. 2012;19(1):44-51. https://doi.org/10.1583/11-3692.1
Gavrilenko AV, Ivanov VA, Kuklin AV, Al’-Yusef NN. Neposredstvennye rezul’taty operatsii sonnopodklyuchichnogo shuntirovaniya i endovaskulyarnykh metodov lecheniya pri stenoze pervogo segmenta podklyuchichnoi arterii. Annaly khirurgii. 2014;2:24-28. (In Russ.).
Özdemir-VAN Brunschot DM, Reijnen MM, VAN Oostayen JA, Schultze Kool LJ, VAN DER Vliet JA. Endovascular versus surgical revascularization in proximal subclavian artery obstruction. Journal of Cardiovascular Surgery. 2016;57(5):640-645.
Galyfos GC, Kakisis I, Maltezos C, Geroulakos G. Open versus endovascular treatment of subclavian artery atherosclerotic disease. Journal of Vascular Surgery. 2019;69(1):269-279.e7. https://doi.org/10.1016/j.jvs.2018.07.028
Vachev AN, Dmitriev OV, Golovin EA, Stepanov MYu. Optimal’nyi metod rekonstruktsii u patsientov s patologiei 1 segmenta podklyuchichnoi arterii. Angiologiya i sosudistaya khirururgiya. 2020;26(2):133-139.(In Russ.). https://doi.org/10.33529/ANGIO2020218

Close metadata