New subclavian artery angioplasty technique for treating subclavian coronary steal syndrome.

Left subclavian artery stenting is usually performed through the standard femoral route using a guiding catheter technique. This technique has obvious drawbacks in the case of coronary subclavian steal due to the poor opacification of the left internal mammary artery (LIMA) ostium, and difficult access to the LIMA in the case of plaque shifting, especially when the vertebral artery and the LIMA ostia are very close to the left subclavian artery stenosis. We have developed an "ad hoc" technique to minimize catheter manipulation and contrast injection, and to optimize LIMA and vertebral artery visibility during stent implantation, which includes access through the brachial artery and a long sheath guiding catheter. This technique should be preferred to the standard femoral route because of its intrinsic advantages.