Endovascular therapy of left subclavian artery stenosis in patients with left internal mammary-coronary artery bypass graft

We wanted to evaluate the clinical usefulness of percutaneous transluminal angioplasty (PTA) and stenting of left subclavian artery (LSA) stenosis in the patients with a left internal mammary artery (LIMA)-coronary artery bypass graft. From September 1998 to November 2005, significant proximal LSA stenoses were treated with PTA and stenting in 22 patients (15 men and 7 women) who had a prior LIMA-coronary artery bypass graft or who were willing to undergo LIMA-coronary artery bypass grafting. The technical success rates, complications and restenosis during the follow-up period were retrospectively evaluated. Six patients had a prior LIMA bypass graft and 16 patients were treated before their coronary artery bypass surgery. The etiology of the LSA stenosis was atherosclerosis in all patients. Four patients were treated with PTA only, and stents were placed in 18 patients. Technical success was achieved in all patients. An embolism in the proximal LIMA occurred after stenting in one patients, and the LIMA was recanalized with transcatheter thrombolysis. During a mean follow-up of 30 months, only one patients was found to have recurrent LSA stenosis 29 months after stenting and this patient was successfully managed with angioplasty. Endovascular therapy is useful and efficacious for the treatment of LSA stenosis in patients with a LIMA-coronary artery bypass graft