Subclavian, brachiocephalic and vertebral interventions

Summary

The prevalence of subclavian, brachiocephalic and vertebral artery occlusive disease due to atherosclerotic disease in the general population is unknown as these conditions often remain undiagnosed because, very frequently, they are either asymptomatic or are due to neglected symptoms of vertebro-basilar and/or upper extremity ischaemia.

Subclavian and brachiocephalic endovascular interventions are procedures that are both feasible and acceptably safe. Nevertheless, the need for correct clinical judgment and patient selection must be emphasised.

In vertebral artery disease, asymptomatic subjects do not require revascularisation. In general, it is only patients with recurrent ischaemic events despite antiplatelet therapy or with refractory vertebro-basilar hypoperfusion in whom revascularisation should be considered.

With regard to subclavian artery disease, revascularisation is rarely indicated in asymptomatic patients 11. European Stroke Organisation; Authors/Task Force Members, Tendera M, Aboyans V, Bartelink ML, Baumgartner I, Clément D, Collet JP, Cremonesi A, De Carlo M, Erbel R, Fowkes FG, Heras M, Kownator S, Minar E, Ostergren J, Poldermans D, Riambau V, Roffi M, Röther J, Sievert H, van Sambeek M, Zeller T; ESC Committee for Practice Guidelines, Bax J, Auricchio A, Baumgartner H, Ceconi C, Dean V, Deaton C, Fagard R, Funck-Brentano C, Hasdai D, Hoes A, Knuuti J,...