Clinical Analysis Of Percutaneous Endovascular Interventional Technology Applied In The Stenosis And Occlusion Of Subclavian Artery

Objective: To investigate the clinical effects of percutaneous endovascular interventional technology treatment for the stenosis and occlusion of subclavian artery. Compare the differences in treatments and clinical effects, when endovascular interventional technology applied in the initiation part and the rest part of subclavian artery lesion.Methods: Study thirty-seven patients with the stenosis and occlusion of subclavian artery retrospectively,all the patients were treated in our hospital in the past seven years. All the patients'diagnosis were comfirmed by transcranial Doppler (TCD) and X-ray computed tomography angiography (CTA) before preoperation: 24 cases of subclavian artery stenosis, 13 cases of occlusion; 32 cases of the initiation part of subclavian artery lesion, 5 cases of the rest part of subclavian artery lesion. Before operation, all patients had received regular anticoagulant therapy for 3~5days, and controlled blood pressure, blood glucose in the normal range roughly. All patients received the endovascular interventional therapy under the guidance of digital subtraction angiography (DSA), including angiography, angioplasty or stent placement. Check routine blood coagulation everyday, and adjust the dose of anticoagulant timely. Now observe the improvement of postoperative clinical symptoms, the incidence of complications and the medium and long-term therapeutic effects, etc, retrospectively.Results: 31 cases achieved successful operation of the total 37 cases, the success rate was 84% overall; 23 cases of the stenosis of subclavian artery achieved successful operation of the 24 cases, the success rate was 96%, One successful case diagnosed by CTA was moderate stenosis preoperatively, but according to the lateral surgical angiography imaging, the stenosis degree was less than 50%, so only puted one catheter in the vascular to dissolve the thrombo-embolism.One failed case diagnosed by CTA was severe stenosis preoperatively, but the operation was still not success, although opened the humerus artery pathways intraoperatively, the patient accepted carotid artery-subclavian artery bypass operation later in the vascular surgery division. 8 cases of the occlusion of subclavian artery achieved successful operation of the 13 cases, the success rate was 62%. Using another classification method, 26 cases of the initiation part of subclavian artery lesion achieved successful operation of the 32 cases, 6 cases failed, the success rate was 81%.5 cases of the rest part of subclavian artery lesion all achieved successful operations. In 31 cases of surgical success, 9 cases opened the brachial artery pathway, but all the endovascular stents conveying system were released via the femoral artery pathway. The patients who existed SSS preoperatively reviewed TCD after the operation, the SSS phenomenon all disappeared. All the clinical symptoms improved observably or disappeared postoperatively. Except for one acute embolization in distal artery, no serious complications happened. In the 31 cases of achieving vascular cavity interventional therapy with success, there were two cases treated with PTA allied with PTSP appeared restenosis in 3 months ,24 months respectively after operation, another endovascular stent implanted in each patient once more. there were two cases treated with pure PTA appeared restenosis in 8 months ,48 months respectively after operation, another endovascular stent implanted in each patient once more, but one case appeared restenosis after the second stent implanted for 30 months, the patient accepted carotid artery-subclavian artery bypass operation later in the vascular surgery division. One case died of sudden intracerebral hemorrhage when accepting subclavian artery and internal carotid artery stent implantation at the same time for 3 months.In 5 cases of the rest part of subclavian artery lesion, 4 cases accepted stent implantation, 1 case accepted pure PTA. During a follow-up of 6 months to 7 years, all of the 5 cases were cured without recurrence and complications. One year, three years, five years'patency rate was 85%, 93%, 82% respectively.Conclusion: Percutaneous transluminal interventional therapy applied for the stenosis and occlusion of subclavian artery is safe and effective; Compared with pure PTA, PTA allied with PTSP can receive higher medium and long-term patency rates; Compared with the initiation part of subclavian artery lesion, the rest part can achieve heigher rates in successful operation and medium and long-term patency.