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Subklavian arter hastalığında kobalt krom stentlerin uygulaması

Yıl 2016, Cilt: 7 Sayı: 4, 89 - 93, 28.11.2016
https://doi.org/10.18663/tjcl.42518

Öz

Amaç: Üst ekstremiteyi etkileyen iskemik problemlerden biri subklavian arter darlığıdır. Son zamanlarda endovasküler tedavi, cerrahi tedaviye alternatif bir tedavi olmuştur. Bu çalışmanın amacı hastalıkla baş etmede yeni bir yol olarak sol subklavian arter hastalığında (LSAH) kobalt krom stentin endovasküler tedavide etkinliğini araştırmaktır.


Gereç ve Yöntemler: Nisan 2011 ile Aralık 2014 yılları arasında LSAH nedeniyle endovasküler tedavi yapılan 30 hasta geriye dönük olarak incelendi. Hastaların vertebrobaziler yetmezlik (16 hasta, %53), sol kol iskemisi (5 hasta, %17) ve anjina (4 hasta, %13,3) semptomları mevcuttu. Tüm hastalarda sol subklavian arter proksimal bölgesi etkilenmişti.


Bulgular: 25 hastada (%72) sol subklavian arter darlığı, 5 hastada (%28) ise tam tıkalı lezyon mevcuttu. Ortalama lezyon uzunluğu 21,60 ± 4,58 mm idi. Ortalama damar çapı 8,7 ± 3,8 mm ve lezyon tipi %40 hastada egzantrikti. Tüm hastalarda kobalt krom balonla genişleyen stent kullanıldı. Teknik başarı %100 idi. Endovasküler tedavi sonrası bir yıllık takipte yeniden daralma izlenmedi.


Sonuçlar: Kobalt krom balonla genişleyen stent avantajlı özellikleri nedeniyle LSAH da başarılı sonuçlara sahiptir.

Kaynakça

  • Ochoa VM, Yeghiazarians Y. Subclavian artery stenosis: a review for the vascular medicine practitioner. Vasc Med 2011; 16: 29-34.
  • Shadman R, Criqui MH, Bundens WP, et al. Subclavian artery stenosis: Prevalence, risk factors, and association with cardiovascular diseases. J Am Coll Cardiol 2004; 44: 618 -23.
  • Sueoka BL. Percutaneous transluminal stent placement to treat subclavian steal syndrome. J Vasc Interv Radiol 1996; 7: 351-6.
  • Bryan AJ, Hicks E, Lewis MH. Unilateral digital ischaemia secondary to embolisation from subclavian atheroma. Ann R Coll Surg Engl 1989; 71: 140-2.
  • Olsen CO, Dunton RF, Maggs PR, Lahey SJ. Review of coronarysubclavian steal following internal mammary artery-coronaryartery bypass surgery. Ann Thorac Surg 1988; 46: 675-8.
  • Wang KQ, Yuan C, Zhang WD, et al. Endovascular therapy and arterial bypass for subclavian artery occlusion. Chin J Surg 2006; 44: 584-7.
  • Motarjeme A, Gordon GI. Percutaneous transluminal angioplasty of the brachiocephalic vessels: guidelines for therapy. Int Angiol 1993; 12: 260-9.
  • Rutherford RB, Baker JD, Ernst C, et al. Recommended standards for reports dealing with lower extremity ischemia: revised version. J Vasc Surg 1997; 26: 517-38.
  • English JA, Carell ES, Guidera SA, Tripp HF. Angiographic prevalence and clinical predictors of left subclavian stenosis in patients undergoing diagnostic cardiac catheterization. Catheter Cardiovasc Interv 2001; 54: 8-11.
  • Rodriguez-Lopez JA, Werner A, Martinez R, Torruella LJ, Ray LI, Diethrich EB. Stenting for atherosclerotic occlusive disease of the subclavian artery. Ann Vasc Surg 1999; 13: 254-260.
  • Schillinger M, Haumer M, Schillinger S, Mlekusch W, Ahmedi R. Outcome of conservative versus interventional treatment of subclavian artery stenosis. J Endovasc Ther 2002; 9: 139-46.
  • Williams SJ. Chronic upper extremity ischemia: current concepts in management. Surg Clin North Am 1986; 66: 355-75.
  • Vitti MJ, Thompson BW, Read RC, et al. Carotid–subclavian bypass: a twenty-two-year experience. J Vasc Surg 1994; 20: 411-18.
  • Perler BA, Williams GM. Carotid–subclavian bypass: a decade of experience. J Vasc Surg 1990; 12: 716-23.
  • Kretschmer G, Teleky B, Marosi L, et al. Obliterations of the proximal subclavian artery: to bypass or to anastomose? J Cardiovasc Surg 1991; 32: 334-9.
  • Cinà CS, Safar HA, Laganà A, Arena G, Clase CM. Subclavian carotid transposition and bypass grafting: consecutive cohort study and systematic review. J Vasc Surg 2002; 35: 422-9.
  • Van der Vliet JA, Palamba HW, Scharn DM, van Roye SF, Buskens FG. Arterial reconstruction for subclavian obstructive disease: a comparison of extrathoracic procedures. Eur J Vasc Endovasc Surg 1995; 9: 454-8.
  • Al-Mubarak N, Liu MW, Dean LS, et al: Immediate and late outcomes of subclavian artery stenting. Catheter Cardiovasc Interv 1999; 46: 169-72.
  • Patel SN, White CJ, Collins TJ, et al. Catheter-based treatment of the subclavian and innominate arteries. Catheter Cardiovasc Interv 2008; 71: 963-8.
  • Wang KQ, Wang ZG, Yang BZ, et al. Long-term results of endovascular therapy for proximal subclavian arterial obstructive lesions. Chin Med J 2010; 123: 45-50.
  • Kastrati A, Mehilli J, Dirschinger J, et al. Intracoronary stenting and angiographic results strut thickness effect on restenosis outcome (ISAR-STEREO) trial. Circulation 2001; 103: 2816-21.
  • Kolandaivelu K, Swaminathan R, Gibson WJ, et al. Stent thrombogenicity early in high-risk interventional settings is driven by stent design and deployment and protected by polymer- drug coating. Circulation 2011; 123:1400-9.
  • Brogneaux C, Sprynger M, Magnée M, Lancellotti P. European Society for Cardiology. 2011 ESC guidelines on the diagnosis and treatment of peripheral artery diseases. Rev Med Liege 2012; 67: 560-5.

Application of cobalt chromium stents in the subclavian arterial disease

Yıl 2016, Cilt: 7 Sayı: 4, 89 - 93, 28.11.2016
https://doi.org/10.18663/tjcl.42518

Öz

Aim: One of the ischemic problems influencing the upper extremities is subclavian artery stenosis. Recently, endovascular management has become a therapy alternative to surgical treatment. This study aims to investigate the effectiveness of the endovascular therapy with cobalt chromium stent in the left subclavian arterial disease (LSAD) as a novelty.


Material and Methods: 30 patients who underwent endovascular therapy because of LSAD were retrospectively investigated from April 2011 to December 2014. They have symptoms of vertebrobasilar insufficiency (16 patients, 53%), arm ischemia (5 patients, 17 %), and angina (4 patients, 13.3%). All patients had proximal region stenosis or total occlusion in the left subclavian artery.


Results: 25 patients (72%) had left subclavian artery stenosis, whereas five patients (28%) had left subclavian artery total occlusion. The average lesion length was 21.60 ± 4.58 mm. The average vessel diameter was 87 ± 3.8 mm. Eccentric types of lesions were encountered in stenotic cases (n= 12, 40%). Predilatation was performed in 7 patients. Average stent length was 33.1±12.2 mm. Cobalt chromium stent balloon-expandable stents were used for all patients. Technical success in the endovascular treatment was 100%. One year after the endovascular intervention, no seen restenosis were observed.

Conclusion: Due to the advantageous features, cobalt chromium balloon-expandable stents have produced successful results in LSAD.

Kaynakça

  • Ochoa VM, Yeghiazarians Y. Subclavian artery stenosis: a review for the vascular medicine practitioner. Vasc Med 2011; 16: 29-34.
  • Shadman R, Criqui MH, Bundens WP, et al. Subclavian artery stenosis: Prevalence, risk factors, and association with cardiovascular diseases. J Am Coll Cardiol 2004; 44: 618 -23.
  • Sueoka BL. Percutaneous transluminal stent placement to treat subclavian steal syndrome. J Vasc Interv Radiol 1996; 7: 351-6.
  • Bryan AJ, Hicks E, Lewis MH. Unilateral digital ischaemia secondary to embolisation from subclavian atheroma. Ann R Coll Surg Engl 1989; 71: 140-2.
  • Olsen CO, Dunton RF, Maggs PR, Lahey SJ. Review of coronarysubclavian steal following internal mammary artery-coronaryartery bypass surgery. Ann Thorac Surg 1988; 46: 675-8.
  • Wang KQ, Yuan C, Zhang WD, et al. Endovascular therapy and arterial bypass for subclavian artery occlusion. Chin J Surg 2006; 44: 584-7.
  • Motarjeme A, Gordon GI. Percutaneous transluminal angioplasty of the brachiocephalic vessels: guidelines for therapy. Int Angiol 1993; 12: 260-9.
  • Rutherford RB, Baker JD, Ernst C, et al. Recommended standards for reports dealing with lower extremity ischemia: revised version. J Vasc Surg 1997; 26: 517-38.
  • English JA, Carell ES, Guidera SA, Tripp HF. Angiographic prevalence and clinical predictors of left subclavian stenosis in patients undergoing diagnostic cardiac catheterization. Catheter Cardiovasc Interv 2001; 54: 8-11.
  • Rodriguez-Lopez JA, Werner A, Martinez R, Torruella LJ, Ray LI, Diethrich EB. Stenting for atherosclerotic occlusive disease of the subclavian artery. Ann Vasc Surg 1999; 13: 254-260.
  • Schillinger M, Haumer M, Schillinger S, Mlekusch W, Ahmedi R. Outcome of conservative versus interventional treatment of subclavian artery stenosis. J Endovasc Ther 2002; 9: 139-46.
  • Williams SJ. Chronic upper extremity ischemia: current concepts in management. Surg Clin North Am 1986; 66: 355-75.
  • Vitti MJ, Thompson BW, Read RC, et al. Carotid–subclavian bypass: a twenty-two-year experience. J Vasc Surg 1994; 20: 411-18.
  • Perler BA, Williams GM. Carotid–subclavian bypass: a decade of experience. J Vasc Surg 1990; 12: 716-23.
  • Kretschmer G, Teleky B, Marosi L, et al. Obliterations of the proximal subclavian artery: to bypass or to anastomose? J Cardiovasc Surg 1991; 32: 334-9.
  • Cinà CS, Safar HA, Laganà A, Arena G, Clase CM. Subclavian carotid transposition and bypass grafting: consecutive cohort study and systematic review. J Vasc Surg 2002; 35: 422-9.
  • Van der Vliet JA, Palamba HW, Scharn DM, van Roye SF, Buskens FG. Arterial reconstruction for subclavian obstructive disease: a comparison of extrathoracic procedures. Eur J Vasc Endovasc Surg 1995; 9: 454-8.
  • Al-Mubarak N, Liu MW, Dean LS, et al: Immediate and late outcomes of subclavian artery stenting. Catheter Cardiovasc Interv 1999; 46: 169-72.
  • Patel SN, White CJ, Collins TJ, et al. Catheter-based treatment of the subclavian and innominate arteries. Catheter Cardiovasc Interv 2008; 71: 963-8.
  • Wang KQ, Wang ZG, Yang BZ, et al. Long-term results of endovascular therapy for proximal subclavian arterial obstructive lesions. Chin Med J 2010; 123: 45-50.
  • Kastrati A, Mehilli J, Dirschinger J, et al. Intracoronary stenting and angiographic results strut thickness effect on restenosis outcome (ISAR-STEREO) trial. Circulation 2001; 103: 2816-21.
  • Kolandaivelu K, Swaminathan R, Gibson WJ, et al. Stent thrombogenicity early in high-risk interventional settings is driven by stent design and deployment and protected by polymer- drug coating. Circulation 2011; 123:1400-9.
  • Brogneaux C, Sprynger M, Magnée M, Lancellotti P. European Society for Cardiology. 2011 ESC guidelines on the diagnosis and treatment of peripheral artery diseases. Rev Med Liege 2012; 67: 560-5.
Toplam 23 adet kaynakça vardır.

Ayrıntılar

Konular Sağlık Kurumları Yönetimi
Bölüm Özgün Makale
Yazarlar

Ersin Sarıçam

Yayımlanma Tarihi 28 Kasım 2016
Yayımlandığı Sayı Yıl 2016 Cilt: 7 Sayı: 4

Kaynak Göster

APA Sarıçam, E. (2016). Subklavian arter hastalığında kobalt krom stentlerin uygulaması. Turkish Journal of Clinics and Laboratory, 7(4), 89-93. https://doi.org/10.18663/tjcl.42518
AMA Sarıçam E. Subklavian arter hastalığında kobalt krom stentlerin uygulaması. TJCL. Kasım 2016;7(4):89-93. doi:10.18663/tjcl.42518
Chicago Sarıçam, Ersin. “Subklavian Arter hastalığında Kobalt Krom Stentlerin Uygulaması”. Turkish Journal of Clinics and Laboratory 7, sy. 4 (Kasım 2016): 89-93. https://doi.org/10.18663/tjcl.42518.
EndNote Sarıçam E (01 Kasım 2016) Subklavian arter hastalığında kobalt krom stentlerin uygulaması. Turkish Journal of Clinics and Laboratory 7 4 89–93.
IEEE E. Sarıçam, “Subklavian arter hastalığında kobalt krom stentlerin uygulaması”, TJCL, c. 7, sy. 4, ss. 89–93, 2016, doi: 10.18663/tjcl.42518.
ISNAD Sarıçam, Ersin. “Subklavian Arter hastalığında Kobalt Krom Stentlerin Uygulaması”. Turkish Journal of Clinics and Laboratory 7/4 (Kasım 2016), 89-93. https://doi.org/10.18663/tjcl.42518.
JAMA Sarıçam E. Subklavian arter hastalığında kobalt krom stentlerin uygulaması. TJCL. 2016;7:89–93.
MLA Sarıçam, Ersin. “Subklavian Arter hastalığında Kobalt Krom Stentlerin Uygulaması”. Turkish Journal of Clinics and Laboratory, c. 7, sy. 4, 2016, ss. 89-93, doi:10.18663/tjcl.42518.
Vancouver Sarıçam E. Subklavian arter hastalığında kobalt krom stentlerin uygulaması. TJCL. 2016;7(4):89-93.


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