Angioplasty versus stenting for subclavian artery stenosis

The subclavian arteries are two major arteries of the upper chest, below the collar bone, that come from the arch of the aorta. The left subclavian artery supplies blood to the left arm and the right subclavian artery supplies blood to the right arm, with some branches supplying blood to the head and chest. A history of smoking, high blood pressure, lower levels of 'good' (high density lipoprotein) cholesterol and peripheral arterial disease are associated with an increased risk of subclavian artery narrowing or stenosis. Subclavian artery stenosis is often without symptoms. Symptoms when they occur include short-lasting vertigo, commonly described as the environment spinning, due to decreased blood flow in the back part of the brain and blood circulation problems in the hands and arms.
Endovascular treatment for stenosis of the subclavian arteries includes angioplasty alone and with stenting. We could not find any randomised controlled trials in the medical literature that compared the effectiveness and safety of stent implantation with angioplasty alone for treatment of subclavian artery lesions. We conclude that there is currently insufficient evidence to determine whether stenting is more effective than angioplasty alone.

Authors' conclusions: 

There is currently insufficient evidence to determine whether stenting is more effective than angioplasty alone for stenosis of the subclavian artery.

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Background: 

There is insufficient evidence to guide stent usage following angioplasty in subclavian artery stenosis. This is an update of a review first published in 2011.

Objectives: 

The aim of this review was to determine whether stenting is more effective than angioplasty alone for stenosis of the subclavian artery.

Search strategy: 

For this update the Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (last searched February 2014) and CENTRAL (2014, Issue 1). There was no restriction on language.

Selection criteria: 

Randomised controlled trials of endovascular treatment of subclavian artery lesions comparing angioplasty alone and stent implantation.

Data collection and analysis: 

Two authors independently evaluated studies to assess eligibility. Discrepancies were resolved by discussion. If there was no agreement, the third author was asked to assess the study for inclusion.

Main results: 

To date we have not identified any completed or ongoing randomised controlled trials comparing percutaneous transluminal angioplasty and stenting for subclavian artery stenosis.