Identifying high-risk patients for percutaneous transluminal angioplasty of subclavian and innominate arteries.

We have performed percutaneous transluminal angioplasty for 7 subclavian (4 stenoses, 3 occlusions) and 2 innominate (both stenoses) artery obstructions in 7 patients by percutaneous femoral approach in all, and ipsilateral percutaneous brachial puncture in 2, patients. Initial success was obtained in 4 of the 6 stenoses (2 subclavian and both innominate) but in none of the 3 occlusions. Three of the 4 subclavian stenoses were located proximal to the vertebral artery origin and antegrade vertebral flow without subclavian steal was present in 2 of these lesions. Three patients had complications during the procedure. Two of them developed symptoms and signs of cerebral embolization. Both had shown antegrade vertebral flow and no evidence of subclavian steal in the initial angiogram. The third patient developed angina pectoris. The follow-up period ranged from 4 to 18 months (mean 10.8 months) and no re-stenosis was detected. Angioplasty appears suitable for management of a selected group of patients with nonocclusive lesions in whom subclavian steal phenomenon is evident in the initial diagnostic angiogram. The patients with antegrade vertebral flow are at a high risk of cerebral embolization during angioplasty.