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  • Title: Angioplasty with or without stent placement in the brachiocephalic artery: feasible and durable? A retrospective cohort study.
    Author: van Hattum ES, de Vries JP, Lalezari F, van den Berg JC, Moll FL.
    Journal: J Vasc Interv Radiol; 2007 Sep; 18(9):1088-93. PubMed ID: 17804769.
    Abstract:
    PURPOSE: To evaluate the results of percutaneous transluminal angioplasty (PTA) and stent placement in isolated brachiocephalic trunk lesions. MATERIALS AND METHODS: PTA, with or without stent placement, was used to treat 30 patients with isolated clinically significant stenoses (n = 25) or occlusions (n = 5) of the brachiocephalic artery. Initial clinical success was defined as a relief or substantial reduction of the preprocedural symptoms, and initial technical success was defined as a mean translesion pressure gradient of less than 5 mm Hg or a residual stenosis of less than 20%. Clinical evaluation and duplex Doppler ultrasonography of the lesion site were performed at follow-up. Clinical restenosis was defined as recurrent clinical symptoms and a lumen reduction of more than 50%, determining the primary clinical patency. Technical restenosis was defined as more than 50% lumen reduction with or without renewed clinical symptoms, determining the primary technical patency. RESULTS: The initial technical success rate was 83% (occlusions, 60%; stenoses, 88%), and the clinical success rate was 81%. Two patients had major complications, and four experienced minor complications. At a median follow-up of 24 months (4 weeks to 92 months), the primary clinical patency rate was 79% (95% confidence interval [CI]: 57%, 104%), with 83% (95% CI: 60%, 105%) for arteries with stents and 67% (95% CI: 13%, 120%) for those without stents (P = .11). The primary technical patency rate was 50% (95% CI: 24%, 76%). CONCLUSION: PTA with or without stent placement in a stenotic or occlusive brachiocephalic artery is a procedure of tolerable safety with a high initial success rate; however, only moderately rewarding results were obtained after 2 years. Selective stent placement probably improves long-term success. Primary PTA with selective stent placement in an atherosclerotic obstructive brachiocephalic artery should be considered the preferred treatment option.
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