Endovascular treatment of subclavian artery occlusive disease

This case report demonstrates the bidirectional endovascular treatment of a severe calcified CTO of the brachiocephalic trunk and the right common carotid artery


    Great case Özgün!
    Just two questions:
    1) Why did you use both transfemoral and transbrachial access? Don’t you think that a revascularization through only a transbrachial access would be feasible?
    2) Do you always use bare metal stents for subclavian disease?

    Thank you, Konstantinos!
    1) when I first saw the CT scan I was sure, this lesion would be – because of the calcified occlusion- difficult to treat. So I wanted a proper imaging of the arch by a transfemoral access. My plan A was a retrograde, transbrachial recanalization but I was not successful. Despite my first suggestion, I was able to get a low profile wire from transfemoral through the occlusion (plan B), but it was not possible to follow a balloon or a catheter to change for a stiffer wire. So I decided to create a pull through wire (plan C) by snaring over the already created trsnsbrachial access.

    2) no I usually prefer covered BE Stents for subclavian diseases. But in this case, the calcification was very severe. I wanted the highest available radial force. I know that the COBEST Trial demonstrated improved patency of PTFE-covered stents when compared with bare metal stents in the aortoiliac territory. In view of the relatively small patient population with subclavian diseases, a randomized trial is still missing. COBEST might be point toward covered Stents, but I recommended, in this case, an individual choice. Bare metal BE Stent with high radial force because of the heavily calcified occlusion.

    I hope the answers will point out my strategy. Thank you for your comment!

    June 17, 2019

    Great presentation and Fantastic use of Endovascular IR Techniques. .

    My Questions are about :
    1.Why Not Use Paclitaxel drug coated balloons in the treatment of Subclavian Arterial Atherosclerotic stenosis?

    2. Instead of Snaring CTO Wires to gain access through heavily Calcified lesion; use “DABRA Laser Atherectomy” device and then do balloon dilation, deploy balloon expandable high radial force BMS. .

    Thank you for your questions.
    I prefer an endovascular treatment of subclavian lesions. Therefore, the level of evidence is very poor to choose the right device (POBA, DCB or BMS).
    Generally the SCA lesions are heavily calcified lesions. Compared to the common iliacs I prefer a balloon expandable stent.
    I don’t have any experience with laser atherectomy. It would be great to see a case report or some visual results you have. You can upload it here on Vascupedia!

    Kind regards

    Thank you for your questions. I recommend endovascular therapy for subclavian artery diseases. Generally, you have to treat calcified lesions in this area. Like in the common iliacs I prefer a balloon expandable Stent. There is still no evidence for POBA, DCB or BMS for the treatment of SCA.
    Your second question is very interesting. I have no experience with a laser atherectomy device. I have to learn more about it.
    Is it possible to share your experience with us? Maybe a small case report here on Vascupedia?

    Kind regards.

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