Diagnosis and management of subclavian artery stenosis prior to coronary artery bypass grafting in the current era

Jason H Rogers, Royce F. Calhoun

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

There are several approaches to managing subclavian artery stenosis (SAS) prior to coronary artery bypass grafting (CABG) with an intended internal thoracic artery (ITA) graft to the left anterior descending (LAD) artery. We herein review the incidence of and various diagnostic modalities for detecting SAS. Published relevant clinical studies from the interventional cardiovascular and cardiac surgical literature are summarized. Particular emphasis is placed on the efficacy of various approaches to the patient diagnosed with SAS prior to CABG. Stenting the subclavian artery prior to bypass surgery and using an in situ ITA is compared to using the ITA as a "free" graft. The incidence of restenosis after subclavian artery angioplasty or stenting is not trivial and has been reported to occur at a rate of 6% to 21%; however, the average rate of restenosis with stenting appears to be in the mid-teens. Subacute subclavian stent thrombosis or occlusion is exceptionally rare, suggesting that a percutaneous approach to SAS is reasonable prior to CABG. For patients requiring emergent revascularization, placement of a free ITA graft to the LAD appears to be a safe and durable treatment as patency rates are comparable to that of an in situ LITA to the LAD. In summary, although no randomized clinical trials address the optimal management of SAS prior to CABG, both percutaneous and surgical options appear to be safe and reasonably durable.

Original languageEnglish (US)
Pages (from-to)20-25
Number of pages6
JournalJournal of Cardiac Surgery
Volume22
Issue number1
DOIs
StatePublished - Jan 2007

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Subclavian Steal Syndrome
Coronary Artery Bypass
Mammary Arteries
Subclavian Artery
Transplants
Incidence
Angioplasty
Stents
Thrombosis
Randomized Controlled Trials
Arteries

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Diagnosis and management of subclavian artery stenosis prior to coronary artery bypass grafting in the current era. / Rogers, Jason H; Calhoun, Royce F.

In: Journal of Cardiac Surgery, Vol. 22, No. 1, 01.2007, p. 20-25.

Research output: Contribution to journalArticle

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