Subclavian Artery Stenting

Due to the short- and long-term consequences, as well as patency difficulties, treatment for subclavian artery blockage is still up for debate. We present a rare instance of bilateral internal carotid artery occlusion and coupled proximal segmental occlusion of the left subclavian artery and subclavian steal phenomenon. Depending on the severity of the stenosis, the patient may exhibit symptoms or be asymptomatic. Upper extremity claudication, vertigo, diplopia, or syncope are some of the symptoms. A complete investigation using ultrasound Doppler, magnetic resonance angiogram (MRA), and computed tomography angiography (CTA) is undertaken to delineate the diagnosis when a blood pressure differential in the upper arms is greater than 15 mmHg. The management strategy involves medical care, endovascular therapy, and lifestyle changes, depending on the extent of the clinical manifestation. Endovascular stenting and angioplasty should be used as initial treatments for symptomatic subclavian artery occlusive disease. If it fails, open surgery should be taken into consideration. Both the subclavian and the axillary arteries bypassing the carotid artery are effective therapy options. People with subclavian artery atherosclerotic occlusive plaques are typically asymptomatic. In the symptomatic patient, intervention is necessary.  Upper limb ischemia symptoms are frequently evident with hemodynamically substantial stenosis of the subclavian artery on the same side as the lesion. Retrograde flow in the ipsilateral vertebral artery may also cause symptoms of vertebrobasilar insufficiency, which are another possible presentation of subclavian steal syndrome. The most frequent cause of subclavian artery stenosis is atherosclerosis, but other causes include congenital abnormalities like arteria lusoria (aberrant subclavian artery) or right-sided aortic arch that can cause compression of the right subclavian artery and result in congenital subclavian steal syndrome. The primary line of treatment for the symptomatic subclavian occlusive disease is angioplasty and stenting. An analysis of this endovascular intervention's long-term results revealed high primary success and positive outcomes for more than ten years. Just proximal to the left vertebral artery's origin and distal to the occlusion, the left subclavian artery was transected and clamped. The stump of the subclavian artery was sealed. Dissection and control of the left common carotid artery were performed. The left common carotid artery underwent a longitudinal arteriotomy, and a left subclavian artery to left common carotid artery anastomosis was completed.

Upper limb ischemia, subclavian steal syndrome, or, less frequently, coronary steal syndrome may be symptoms of subclavian artery stenosis that is hemodynamically severe. We have discussed four techniques for symptomatic subclavian artery stenosis to re-establish blood flow to the upper limb. It is generally agreed upon that the first line of treatment for this problem should be endovascular stenting of the subclavian artery. However, intraluminal hyperplasia and re-stenosis rates are higher with angioplasty than with extrathoracic surgical revascularization. If there is proximal stenosis of the subclavian artery, transposition of the subclavian artery onto the carotid artery is appropriate, allowing for mobilization of the subclavian artery distal to the stenosis. It is safe and the risk of re-occlusion is negligible when treating proximal subclavian artery stenosis. The carotid-axillary bypass is not as popular as the other methods. In circumstances where the subclavian artery has substantial disease and damage from prior angioplasty and stenting, it has the advantage of avoiding the area of stenosis. Even when the subclavian artery has a more distal disease, it can still be done.

 When considering surgical management of subclavian artery stenosis, it is crucial to weigh your choices. Surgical choices may be made more difficult by anatomical variations such as arteria lusoria in addition to atherosclerosis and damage from prior endovascular therapies. When weighing surgical choices, it's critical for the surgeon to have a complete understanding of the anatomy and etiology. In order to treat symptomatic subclavian artery disease, vascular surgeons have a variety of therapeutic choices at their disposal. This unique case series illustrates some of those alternatives.

The best physician for acute stroke mechanical thrombectomy is Dr. Sandeep Sharma. He uses the two approaches in the ideal mix and is a specialist in both suction retrieval and stent retrieval.