Mechanical thrombectomy in proximal subclavian artery in-stent occlusion
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CASE REPORT
Mechanical thrombectomy in proximal subclavian artery in-stent occlusion Roberto Silingardi • Antonio Lauricella • Valentina Cataldi • Mistral Klend Sacha Njila Gioacchino Coppi
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Received: 24 March 2013 / Accepted: 12 July 2013 Ó Japanese Association of Cardiovascular Intervention and Therapeutics 2013
Abstract Purpose Mechanical thrombectomy is an established tool for endovascular therapy of acute/chronic in-stent occlusions of the lower extremities, especially for the superficial femoral artery. The authors report the use of the Rotarex catheter system for an in-stent proximal subclavian occlusion. Case presentation A 51-year-old female patient with previous multiple attempts at left subclavian revascularization; primary endovascular stenting at the origin of the subclavian artery occluded at 3 months, and a carotidsubclavian bypass was placed distally to the stent. After 6 months from the first treatment, the patient was readmitted with an acute left arm ischemia and full occlusion of the bypass was confirmed at computed tomography angiography. An anterograde thrombectomy for in-stent restenosis, together with PTA with a drug-eluting balloon was performed in the subclavian artery with confirmed patency at 6 months. Conclusion Mechanical thrombectomy together with drug-eluting balloon PTA for in-stent occlusion or restenosis of the subclavian artery could be a promising procedure with a lower invasivity and risk with respect to surgical options. Keywords Subclavian artery Subclavian artery stenosis Subclavian artery stenting Mechanical thrombectomy debulking
R. Silingardi A. Lauricella V. Cataldi M. K. S. Njila G. Coppi (&) Department of Vascular Surgery, University of Modena and Reggio Emilia, Nuovo Ospedale S. Agostino Estense, Modena, Via Giardini, 1355, 41100 Baggiovara (MO), Italy e-mail: [email protected]
Introduction Occlusive disease of the proximal subclavian artery was first described by Contorni [1] in 1960 with reversal flow in the vertebral artery. Proximal subclavian artery occlusion is relatively rare and usually asymptomatic due to adequate compensation by the circle of Willis and a rich brachiocephalic collateral circulation [2]. Symptoms associated with proximal subclavian artery occlusion can be as severe as subclavian steal syndrome, arm claudication or weakness and paresthesia related to arm exercise [3], embolization to the fingers [4], or even ischemic events in the vertebro-basilar territory. A coronary-subclavian steal syndrome which can lead to myocardial ischemia [5] could be present in case of internal mammary artery bypass grafts. In these circumstances, surgical or endovascular intervention is indicated. In the rare symptomatic cases, surgical or endovascular intervention is indicated. Even if data regarding long-term results of two types of treatment are limited currently [6–8], both endovascular stenting and extrathoracic surgical bypass are safe and effective treatments for subclavian steal syndrome in the short and medium term; however, extrath
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