PubMed Health⌕ Search

Biomedical subjects

Frans L Moll

Publications and source records attributed to Frans L Moll.

At least 19 recordsLinked to original sources
PubMed2007

Carotid angioplasty and stenting for postendarterectomy stenosis: long-term follow-up.

BACKGROUND: Carotid angioplasty and stenting (CAS) for recurrent stenosis after carotid endarterectomy (CEA) has been proposed as an alternative to redo CEA. Although early results are encouraging, the extended durability remains unknown. We present the long-term surveillance results of CAS for post-CEA restenosis. METHODS: Between 1998 and 2004, 57 CAS procedures were performed in 55 patients (36 men) with a mean age of 70 years. The mean interval between CEA and CAS was 83 months (range, 6 to 245). Nine patients (16%) were symptomatic. RESULTS: CAS was performed successfully in all patients. No deaths or strokes occurred. A periprocedural transient ischemic attack (TIA) occurred in two patients. During a mean follow-up of 36 months (range, 12 to 72 months), two patients exhibited ipsilateral cerebral symptoms (1 TIA, 1 minor stroke). In 11 patients (19%), in-stent restenosis (> or =50%) was detected post-CAS at month 3 (n = 3), 12 (n = 3), 24 (n = 2), 36 (n = 1), 48 (n = 1), and 60 (n = 1). The cumulative rates of in-stent restenosis-free survival at 1, 2, 3, and 4 years were 93%, 85%, 82%, and 76%, respectively. Redo procedures were performed in six patients, three each received repeat angioplasty and repeat CEA with stent removal. The cumulative rates of freedom from reintervention at 1, 2, 3, and 4 years were 96%, 94%, 90%, and 84%, respectively. CONCLUSION: Carotid angioplasty and stenting for recurrent stenosis after CEA can be performed with a low incidence of periprocedural complications with durable protection from stroke. The rate of in-stent recurrent stenosis is high, however, and does not only occur early after CAS but is an ongoing process.

Aged↗
PubMed2006

Statin treatment is not associated with consistent alterations in inflammatory status of carotid atherosclerotic plaques: a retrospective study in 378 patients undergoing carotid endarterectomy.

BACKGROUND AND PURPOSE: Anti-inflammatory qualities are held partially responsible for the reduction of cardiovascular events after statin treatment. We examined the phenotype of carotid atherosclerotic plaques harvested during carotid endarterectomy in relation to the previous use of different statins prescribed in clinical practice. METHODS: Three hundred and seventy-eight patients were included. Atherosclerotic plaques were harvested, immunohistochemically stained and semiquantitively examined for the presence of macrophages (CD68), smooth muscle cells, collagen and fat. Adjacent atherosclerotic plaques were used to study protease activity and interleukin levels. Patients' demographics were recorded and blood samples were stored. RESULTS: Serum cholesterol, low-density lipoprotein, apolipoprotein B, and C-reactive protein levels were lower in patients treated with statins compared with patients without statin treatment. Atheromatous plaques were less prevalent in patients receiving statins compared with patients without statin therapy (29% versus 42%, P=0.04). An increase of CD68 positive cells was observed in patients receiving statins compared with nonstatin treatment (P=0.05). This effect was specifically related to atorvastatin treatment. In patients treated with atorvastatin, the increased amount of CD68 positive cells were not associated with increased protease activity. In contrast, a dose-dependent decrease in protease activity was shown in the atorvastatin group. Interleukin 6 expression was lower in plaques obtained from patients treated with statins (P=0.04). CONCLUSIONS: Statin use may exert pleiotropic effects on plaque phenotype. However, not the presence of macrophages but activation with subsequent protease and cytokine release may be attenuated by statin use.

Antigens, CD↗
PubMed2006

Hemodynamic effect of carotid stenting and carotid endarterectomy.

BACKGROUND: Carotid angioplasty with stent placement (CAS) may offer an alternative treatment to carotid endarterectomy (CEA). However, in contrast to CEA, which has been shown to normalize impaired cerebral hemodynamics, the effects of CAS remain unclear. To investigate alterations in cerebral hemodynamics, we prospectively studied patients undergoing CAS and compared them with a group of similar patients undergoing CEA. METHODS: Twenty-three patients undergoing CAS for recently symptomatic internal carotid artery (ICA) stenosis were prospectively studied. Volume flow in the ICAs and basilar artery (BA) were measured with magnetic resonance volume flow quantification before CAS and 1 month after. The results were compared with those in 13 similar patients undergoing CEA and 40 control subjects without ICA stenosis. RESULTS: After CAS, volume flow in the ipsilateral ICA increased from 114 +/- 17 to 231 +/- 17 mL/min (P < .001), and total volume flow (ICAs plus BA) increased from 495 +/- 24 to 552 +/- 28 mL/min (P < .05). No significant changes were seen in the contralateral ICA and BA after CAS. Total volume flow and flow in the stenosed ICA normalized after CAS compared with control subjects. Volume flow values similarly improved after CEA. CONCLUSIONS: CAS results in a normalization of impaired cerebral hemodynamics, as assessed by magnetic resonance volume flow measurements. The degree of improvement is similar to that seen after CEA.

Aged↗
PubMed2006

Heparin immobilization reduces thrombogenicity of small-caliber expanded polytetrafluoroethylene grafts.

OBJECTIVE: The patency of small-diameter expanded polytetrafluoroethylene (ePTFE) grafts for vascular reconstruction is impaired by acute thrombotic occlusion. Prosthetic materials are thrombogenic and cause platelet adhesion and activation of the coagulation cascade. Heparin is a potent anticoagulant drug widely used to prevent and treat thrombosis. A new ePTFE graft with long-term bonding of heparin is now commercially available in several European countries, but a basic analysis of its mechanism of action in humans has never been performed. This study was performed to evaluate the thrombogenicity of heparin-bonded ePTFE grafts compared with standard ePTFE in a newly developed human ex vivo model. METHODS: Nonanticoagulated blood was drawn from antecubital veins of 10 healthy donors with a 19-gauge needle. The proximal end of a 60-cm ePTFE vascular graft with a diameter of 3 mm was connected to the needle while the distal end was connected to a syringe, which was placed in a syringe pump. Every volunteer served as his or her own control by using a heparin-bonded ePTFE graft on one arm and a standard ePTFE graft on the other arm. The perfusions were performed over 6 minutes with a flow rate of 20 mL/min, corresponding to a shear rate of 74/s. Serial samples were taken at the distal end of the graft for determination of prothrombin fragment 1 + 2, fibrinopeptide A, and P-selectin expression on perfused platelets. Fibrin deposition and platelet deposition were studied by using scanning electronic microscopy. RESULTS: Fibrinopeptide A production over time was significantly reduced on the heparin-bonded ePTFE grafts compared with standard ePTFE grafts (P < .05). There was no increase in the production of prothrombin fragment 1 + 2 or P selectin over time on either type of graft. Scanning electronic microscopy scanning showed platelet deposition and fibrin formation on standard ePTFE grafts, whereas no platelets or fibrin were observed on heparin-bonded ePTFE grafts. CONCLUSIONS: Heparin immobilization substantially reduces the thrombogenicity of small-diameter ePTFE in a newly developed human ex vivo model. In this study, we provide evidence that the mechanism of action of the heparin bonding is due not only to anticoagulant but also to antiplatelet effects. Heparin bonding may be an important improvement of ePTFE, resulting in better patency rates for vascular reconstructions.

Blood Vessel Prosthesis↗
PubMed2006

Consistency in endovascular aneurysm repair suitability assessment requires group decision audit.

INTRODUCTION: Proper selection of patient and stent-graft combinations in endovascular aneurysm repair (EVAR) depends on knowledge and experience with the different types of stents that have to be adapted to the patient's unique abdominal aortoiliac anatomy. The aim of this study was to analyze the consistency and variance in EVAR suitability assessment between clinicians. METHODS: Worksheets that contained anatomic data derived from computed tomography scans and angiography were compiled for 202 patients. Five clinicians, all experienced in EVAR surgery, assessed the anatomic data on the worksheets for suitability for three types of stent-grafts. The obtained 3030 assessments represented a quantification of the likelihood of success the clinician expected for effective and durable sealing and fixation of the stent-graft in EVAR. The Delphi method was used to determine consensus in the thinking process among clinicians, and kappa analysis was used to determine the proportion of variances in the assessment result between clinicians. RESULTS: With the Delphi method, Cronbach alpha values of 0.87, 0.87, and 0.90 were reached for the three types of stent-grafts in the second assessment round. The individual clinician-group correlation in round two was between 0.69 and 0.86 for clinicians 1, 2, 3, and 4. Between clinician 5 and the others, correlation varied between 0.43 and 0.64. The kappa values ranged between 0.32 and 0.51 among clinicians 1, 2, and 3. Between clinician 5 and the others, kappa values between 0.08 and 0.29 were reached. CONCLUSION: EVAR suitability estimation in a cohort of patients is highly consistent in a group of experienced clinicians. The EVAR suitability estimation at the individual patient level varies substantially between clinicians, however. Aggregating expert opinions in abdominal aortic aneurysm anatomic suitability assessment for EVAR had the opportunity to replace individual clinician decision diversification in a more solid and consistent group decision process.

Aged↗
PubMed2006

Dynamic magnetic resonance angiography of the aneurysm neck: conformational changes during the cardiac cycle with possible consequences for endograft sizing and future design.

OBJECTIVE: Proper proximal fixation and stent-graft sealing within the aneurysm neck are critical for endovascular aneurysm repair (EVAR) durability. Computed tomography angiography (CTA) is the gold standard for preoperative sizing of endograft diameters, but the accuracy of these measurements is uncertain because they rely on static images of a dynamic process. The aortic configuration and diameter may change during the cardiac cycle. We studied these phenomena using dynamic electrocardiograph-triggered magnetic resonance angiography (MRA). METHODS: Eleven consecutive EVAR patients were included. Dynamic MRA was used to perform preoperative and postoperative measurements. Changes were measured in transverse aortic sections 10 mm below the lowest renal artery (level A), at the level of the renal arteries (level B), and 3 cm above the lowest renal artery (level C). Data were analyzed using image segmentation software. Aortic area and diameter changes along 256 axes were determined. RESULTS: Dynamic MRA demonstrated significant aortic area changes during the cardiac cycle before and after EVAR at all three measured levels. Pre-EVAR aortic area significantly increased per cardiac cycle: 8.4% at level A; 9.3% at level B; and 13.3% at level C (P < .001 for all levels). Post-EVAR aortic area increased 9.7% at level A, 9.6% at level B, and 15.8% at level C per cardiac cycle (P < .001 for all levels). Significant diameter changes during cardiac cycles were also observed at all three levels. Pre-EVAR mean diameter changed up to 8.9% (P < .001) compared with post-EVAR aortic changes of up to 11.5% (P < .001). EVAR had no effect on change in aortic area and diameter. Dynamic MRA also demonstrated that pulsatile aortic distension was not equal in all axes, but rather occurred as an asymmetrical expansion and contraction. CONCLUSION: In patients with (atherosclerotic) aneurysm disease, the aortic dimensions at the level of and proximal to the aneurysm neck change during the cardiac cycle. This phenomenon is preserved after EVAR. Therefore, maximum diameter using dynamic MRA may not be similar to the maximum diameter with static CTA in all patients, and a standard regimen of 10% to 15% oversizing of an endograft based on static CTA images may be inadequate for some patients. Further studies using dynamic MRA to evaluate effects of different endografts are anticipated, with possible consequences for endograft designs.

Aged↗
PubMed2006

Bilateral traumatic carotid artery dissection in a child.

Traumatic dissection of the carotid artery is an infrequent but serious complication of blunt craniocervical injury. There is controversy regarding the need for diagnostic screening and management. This report presents a child with delayed neurologic symptoms and multiple cerebral infarcts secondary to bilateral extracranial traumatic carotid artery dissection. The pathophysiology, clinical presentation, and treatment options of blunt carotid artery trauma are discussed.

Adolescent↗
PubMed2006

Cognitive functions in carotid artery disease before endarterectomy.

Restorative effects of carotid endarterectomy (CEA) on cognitive functioning in patients with severe atherosclerotic disease presuppose the existence of cognitive deficits prior to the intervention. Thorough examination of this premise received only minor attention. The present study assessed symptomatic and asymptomatic patients with severe unilateral or bilateral stenosis of the carotid arteries one day before CEA. Healthy volunteers with similar demographic characteristics served as control subjects. Patients overall showed decreased functioning on tests of attention, verbal and visual memory, verbal fluency, and psychomotor speed and executive functioning, even after correction for the effects of mood. Simple motor skills and visuospatial functioning were not affected. Patients grouped according to presence and type of previous clinical symptoms and severity of contralateral stenosis only slightly differed from each other. The findings leave open the potential of improving cognitive function after CEA.

Aged↗
PubMed2006

Pediatric penetrating renal artery trauma: stent-graft treatment with 2-year follow-up.

PURPOSE: To report the 2-year follow-up of a pediatric patient who underwent stent-graft repair for penetrating renal artery trauma. CASE REPORT: An 11-year-old boy presented with a single anterior abdominal stab wound. He was normotensive (110/70 mmHg) but tachycardic (120 bpm). A focused abdominal sonogram for trauma revealed significant free intraperitoneal fluid. He underwent an urgent laparotomy, during which a minor liver injury was repaired. A large, nonpulsatile, non-expanding, left-sided retroperitoneal hematoma was identified but not explored. The boy remained hemodynamically unstable, so diagnostic angiography was performed. A single left proximal renal artery perforation was found. The lesion was treated with a 6x17-mm balloon-expandable stent-graft. Completion angiography demonstrated an excellent proximal and distal seal, without evidence of extravasation. The patient's condition stabilized, and he recovered completely. Serial renal duplex scans up to 2 years have documented normal renal artery blood flow and no migration of the stent-graft; the kidneys are equal in size. The serum creatinine level remains normal. CONCLUSION: In appropriately selected patients, transcatheter stent-graft placement is a promising new kidney salvage modality to treat renal artery injury in children. Serious concern remains regarding the placement of covered stents in the pediatric population, as the long-term durability and the adaptability of growing arteries to renal stents are not known.

Blood Vessel Prosthesis Implantation↗
PubMed2006

Pilot study of dynamic cine CT angiography for the evaluation of abdominal aortic aneurysms: implications for endograft treatment.

PURPOSE: To utilize 40-slice electrocardiographically (ECG)-gated cine computed tomographic angiography (CTA) to characterize normal aortic motion during the cardiac cycle at relevant anatomical landmarks in preoperative abdominal aortic aneurysm (AAA) patients. METHODS: In 10 consecutive preoperative AAA patients (10 men; mean age 78.8 years, range 69-86), an ECG-gated CTA dataset was acquired on a 40-slice CT scanner using a standard radiation dose. CTA quality was graded and scan time was measured. Pulsatility measurements at multiple relevant anatomical levels were performed in the axial plane. Changes in aortic circumference were determined for both the aortic wall and the luminal diameter. RESULTS: All 10 CT scans were of good quality. All patients could be scanned in 14 to 33 seconds (mean 21). At each anatomical level measured, there was a 2.2- to 3.4-mm increase in the aortic wall circumference per cardiac cycle. A similar increase was observed in luminal circumference, with a 2.4- to 3.6-mm increase per cycle. CONCLUSION: This study introduces the concept of dynamic cine CTA imaging of aortic motion, providing insight into the pathophysiology of abdominal aortic and iliac pulsations. Patients with AAAs selected for EVAR demonstrate changes in aortic circumference with each cardiac cycle that may have consequences for endograft sizing and future design. The potential for graft migration, intermittent type I endoleak, and poor patient outcome following EVAR can be anticipated. Complex aortic dynamics deserve increased scrutiny in an effort to prevent potential complications.

Aged↗
PubMed2006

Endovascular aneurysm repair alters renal artery movement: a preliminary evaluation using dynamic CTA.

PURPOSE: To observe the natural renal artery motion during cardiac cycles in patients with abdominal aortic aneurysm (AAA) and how the implantation of stent-grafts may distort this movement. METHODS: Data on 29 renal arteries from 15 male patients (mean age 72.6 years, range 66-83) treated with Talent or Excluder stent-grafts were acquired using an electrocardiographically (ECG)-gated dynamic 64-slice CT scanner. ECG-triggered retrospective reconstructions were made at 8 equidistant time points over the R-R cardiac cycle. The gated datasets were reconstructed perpendicular to the center flow lumen of each renal artery at 1.2 and 2.4 cm from the renal ostium. Center of mass displacement was determined per cardiac cycle for pre- and post-EVAR renal arteries and compared. RESULTS: Normal renal artery motion in AAA patients was impressive, with up to 3-mm movement both near and distant from the aorta (mean 2.0+/-0.6 mm, range 1.1-3.0). EVAR inhibited proximal renal motion, resulting in a 31% decrease in maximal movement (mean 1.4+/-0.7 mm, range 0.7-2.0; p < or = 0.05). Distal renal artery motion was unaffected by EVAR, with motion similar to the pre-EVAR state. CONCLUSION: ECG-gated dynamic CTA is feasible on a 64-slice scanner with a standard radiation dose and can detect potentially serious consequences of EVAR. EVAR alters renal artery motion by limiting proximal motion while leaving distal motion unaffected.

Aged↗
PubMed2006

Aortic compliance following EVAR and the influence of different endografts: determination using dynamic MRA.

PURPOSE: To utilize dynamic magnetic resonance angiography (MRA) to characterize aortic stiffness (beta) and elastic modulus (Ep) as indexes of wall compliance during the cardiac cycle and determine any influence of different endograft designs or the presence of endoleaks on these indexes. METHODS: Eleven consecutive patients (11 men; median age 74 years, range 63-78) with abdominal aortic aneurysm (AAA) selected for endovascular repair were scanned pre- and postoperatively. Aortic area and diameter changes during the cardiac cycle were determined using dynamic MRA at 4 levels: 3 cm above the renal arteries, between the renal arteries, 1 cm below the renal arteries, and at the level of maximum aneurysm sac diameter. Ep and beta were calculated. Data are presented as median (range); p<0.05 was considered significant. RESULTS: Preoperatively, Ep and beta were significantly higher at the level of the aneurysm sac compared to all other levels (p<0.05). Following EVAR, stiffness increased at this level (p<0.05). After implantation, patients with an Excluder endograft demonstrated Ep and beta measurements at the aneurysm neck that were 94% and 60% higher, respectively, compared to those with a Talent (p<0.05) endograft. The presence of an endoleak had no effect on Ep or beta. CONCLUSION: This study introduces the feasibility of dynamic MRA imaging-based calculations of aortic elastic modulus and stiffness. AAA patients demonstrate increased Ep and beta at the level of the aneurysm sac. EVAR results in increased aneurysm sac Ep and beta. Stent-graft design seems to alter Ep and beta within the aneurysm neck, which may have consequences for endograft durability. The presence of an endoleak does not seem to have an effect on Ep or beta.

Aged↗
PubMed2005

Dutch iliac stent trial: long-term results in patients randomized for primary or selective stent placement.

PURPOSE: To determine long-term results of the prospective Dutch Iliac Stent Trial. MATERIALS AND METHODS: The study protocol was approved by local institutional review boards. All patients gave written informed consent. Two hundred seventy-nine patients (201 men, 78 women; mean age, 58 years) with iliac artery disease were randomly assigned to undergo primary stent placement (143 patients) or percutaneous transluminal angioplasty (PTA) with selective stent placement in cases in which the residual mean pressure gradient was greater than 10 mm Hg across the treated site (136 patients). Before and at 3, 12, and 24 months and 5-8 years after treatment, all patients underwent assessment, which included duplex ultrasonography (US), ankle-brachial index (ABI) measurement, Fontaine classification of symptoms, and completion of the Rand 36-Item Health survey for quality-of-life assessment. Treatment was considered successful for symptoms if symptoms increased at least one Fontaine grade, for ABI if ABI increased more than 0.10, for patency if peak systolic velocity ratio at duplex US was less than 2.5, and for quality of life if the RAND 36-Item Health Survey score increased more than 15 points. Effects of both treatments on symptoms, quality of life, patency, and ABI were compared by using survival analyses. RESULTS: Patients who underwent PTA and selective stent placement had better improvement of symptoms (hazard ratio [HR], 0.8; 95% confidence limits [CLs]: 0.6, 1.0) than did patients treated with primary stent placement, whereas ABI (HR, 0.9; 95% CLs: 0.7, 1.3), iliac patency (HR, 1.3; 95% CLs: 0.8, 2.1), and score for quality of life for nine survey dimensions did not support a difference between treatment groups. CONCLUSION: Patients treated with PTA and selective stent placement in the iliac artery had a better outcome for symptomatic success compared with patients treated with primary stent placement, whereas data about iliac patency, ABI, and quality of life did not support a difference between groups.

Angioplasty, Balloon↗
PubMed2005

Effect of carotid endarterectomy on patient evaluations of cognitive functioning and mental and physical health.

The prophylactic effect of carotid endarterectomy (CEA) against stroke has been well established. As a consequence of the restoration of cerebral blood supply and reduced risk of stroke, cognitive functioning and perceived health may improve. Fifty-one patients with severe atherosclerotic disease of the carotid artery but without history of major stroke completed the Cognitive Failures Questionnaire and the Short Form 36 Health Survey before CEA and 3 and 12 months thereafter. Before CEA, patients reported significant but small deviations from the norm in physical function, general health, and vitality. Small improvements after CEA were observed in the perception of physical role function, general health, vitality, and mental health. Patients also retrospectively noted a slight worsening of health in the year before surgery and some improvement after surgery. Evaluation of cognitive failures in daily life did not change. Demographic or medical characteristics, such as a history of temporary ischemic symptoms, occlusion of the contralateral artery, and shunt use during surgery, did not affect outcome. In conclusion, no negative outcomes and even some limited positive effects in the perception of mental and physical health are to be expected after CEA.

Aged↗
PubMed2005

Aneurysm diameter and proximal aortic neck diameter influence clinical outcome of endovascular abdominal aortic repair: a 4-year EUROSTAR experience.

Our objective was to evaluate the effect of preoperative aneurysm and aortic neck diameter on clinical outcome after infrarenal abdominal endovascular aneurysm repair (EVAR). Data of patients in the European Collaborators Registry on Stent-Graft Techniques for Abdominal Aortic Aneurysm Repair (EUROSTAR) registry base who underwent EVAR with Talent stent grafts were analyzed. Patient characteristics and clinical outcomes were compared among four groups defined by preoperative abdominal aortic aneurysm (AAA) and proximal aortic neck diameter: A, AAA < or =60 mm and neck < or =26 mm; B, AAA >60 mm and neck < or =26 mm; C, AAA < or =60 mm and neck >26 mm; and D, AAA >60 mm and neck >26 mm. Over a 7-year period, 1,317 patients underwent EVAR. Patients in groups B and D were significantly older and had a higher American Society of Anesthesiologists score compared with groups A and C (p=0.002 and 0.003, respectively). Mortality rate was highest in group D (p=0.002), as were rupture and conversion rates (p=0.015 and 0.037, respectively). This study demonstrates that patients with an AAA >60 mm and a proximal aortic neck >26 mm have worse clinical outcome after EVAR.

Adult↗
PubMed2005

Durability of percutaneous transluminal angioplasty for obstructive lesions of proximal subclavian artery: long-term results.

PURPOSE: Percutaneous transluminal angioplasty (PTA) is one of the treatment options for localized obstruction of the subclavian artery. To document long-term durability of this kind of PTA we report a 10-year single-center experience in 110 patients. METHODS: From January 1993 to July 2003, 110 patients (72 women; mean age, 62 +/- 10 years) underwent PTA of symptomatic (>75%) stenosis (n = 90) or occlusion of the proximal subclavian artery (84 left-sided). Forty one patients (37%) had symptoms of vertebrobasilar insufficiency, 29 patients (26%) had disabling chronic arm ischemia, and 20 patients had both symptoms. Twenty patients with coronary artery disease underwent PTA in preparation for myocardial revascularization with the internal mammary artery. Duplex scans and arteriograms confirmed significant stenosis or occlusion. All PTA procedures were performed with the patient under local anesthesia, through the femoral artery (n = 89), brachial artery (n = 6), or combined route (n = 15). In 59 patients (58%) an additional stent was placed. RESULTS: Angioplasty was initially technically and clinically successful in 102 patients (93%). Seven occlusions could not be recanalized, and 1 procedure had to be stopped because of ischemic stroke. Of the 102 patients in whom treatment was successful, 1 patient (1%) had a minor stroke in the contralateral hemisphere 2 hours post-PTA. Seven patients (7%) had minor problems, all without permanent sequelae. Follow-up with duplex scanning ranged from 3 months to 10 years (mean, 34 months). Primary clinical patency at 5 years was 89%, with a median recurrent obstruction-free period of 23 months. The local complication rate was 4.5%, and the combined stroke and death rate was 3.6%. Significant recurrent obstruction (>70%) developed in 8 patients with clinical symptoms. Four stenoses were successfully treated with repeat PTA (2 with additional stent placement); 4occlusions required surgery. CONCLUSIONS: PTA of obstructive lesions of the proximal subclavian artery is not only an effective initial treatment, but is also successful over the long-term. Inasmuch as all clinical failures occured within 26 months after initial therapy, we recommend regular follow-up for at least 2 years post-PTA. All clinically significant recurrent stenoses can be treated with repeat endovascular procedures. We could not prove positive or negative influence of additional placement of stents; however, the number of recurrent stenoses might be too small in this retrospective study to draw firm conclusions. Adverse events of any kind are certainly no greater than with invasive surgical procedures. Therefore PTA must be seriously considered in patients with localized obstruction of the proximal subclavian artery.

Angioplasty, Balloon↗