From the Guidelines
The initial management for subclavian artery stenosis should focus on medical therapy and risk factor modification, reserving intervention for symptomatic patients or those with severe stenosis causing hemodynamic compromise, as recommended by the 2024 ESC guidelines for the management of peripheral arterial and aortic diseases 1. The management of subclavian artery stenosis involves a comprehensive approach that includes:
- Medical therapy with antiplatelet agents such as aspirin (75-325 mg daily) or clopidogrel (75 mg daily) to prevent thromboembolic complications
- Risk factor modification, including:
- Smoking cessation
- Blood pressure control (target <140/90 mmHg)
- Diabetes management (HbA1c <7%)
- Lipid management with statins (such as atorvastatin 20-80 mg daily) to achieve LDL <70 mg/dL
- Regular exercise and monitoring for progression of symptoms like arm claudication, vertebrobasilar insufficiency, or subclavian steal syndrome Intervention, either endovascular or surgical, is generally reserved for symptomatic patients or those with severe stenosis causing hemodynamic compromise, as stated in the guidelines 1. Key considerations in the management of subclavian artery stenosis include:
- Bilateral arm blood pressure measurement is recommended for all patients with peripheral arterial and aortic diseases, including subclavian artery stenosis 1
- In symptomatic patients, both revascularization options (endovascular ± stenting or surgery) should be considered and discussed case by case by a vascular team 1
- Endovascular revascularization may be considered over surgery due to lower complication rates, despite similar long-term outcomes 1
From the Research
Initial Management for Subclavian Artery Stenosis
The initial management for subclavian artery stenosis involves a combination of medical therapy and interventional procedures.
- Medical therapy typically includes antiplatelet drugs to reduce the risk of cardiovascular events 2.
- Interventional procedures such as percutaneous transluminal angioplasty (PTA) with or without stent implantation, or surgical bypass grafting may be considered for patients with symptomatic subclavian artery stenosis 3, 4, 5, 6.
Treatment Options
Treatment options for subclavian artery stenosis include:
- Combination therapy: antiplatelet drug plus either bypass surgery or PTA with or without stent implantation 2.
- Percutaneous transluminal angioplasty (PTA) and stenting: a minimally invasive procedure to open up the narrowed artery 4, 6.
- Surgical bypass grafting: a surgical procedure to bypass the narrowed artery 3, 5.
Outcomes and Complications
Outcomes and complications of treatment for subclavian artery stenosis include:
- Reduced risk of cardiovascular events and all-cause mortality with combination therapy 2.
- Excellent long-term patency rates with carotid-subclavian bypass 3.
- Technical success rate of 100% with PTA and stenting, but with a risk of restenosis and complications 4, 6.
- Perioperative mortality and morbidity with surgical bypass grafting 3, 5.