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Subclavian > Cases

Totally occluded Subclavian artery lesion recanalization via retrograde approach
- Operator: Seung-Whan, Lee, MD
Clinical Information

- Relevant clinical history and physical exam:
The patients was a 57-year old man with left upper extremity intermittent discomfort for several years. The pulsation of left brachial and radial artery could not be palpable. The coldness on left arm was marked. His coronary risk factors was smoking, only. Blood pressure was measured as 125/71 mmHG on Rt. arm and 93/62 mmHg on Lt. arm.

- Relevant test results prior to catheterization:
CT upper extremity angiography showed segmental occluded the Lt proximal subclavian artery.(Figure 1)

- Relevant angiography findings:
The severe,near-total occlusion of Lt. subclavian ostial part was revealed (Figure 2, Figure 3).

Interventional Management

- Procedural step:
Firstly, we tried antegrade intervention with Rt.femoral route. A 7 Fr sized femoral sheaths was inserted into the right femoral artery. Using 5 Fr head-hunter catheter, and JR4 7 Fr guiding catheter was tried to engage into subclavian artery ostium. But 0.014 inch guidewire (Fielder FC and Choice-PT) could not be advanced due to weak weak guiding back-up support.(Figure 4) Some trial with balloon support wiring made a small antegrade flow. So, we changed strategy into retrograde approach. We punctured weakly palpable radial artery with 7Fr sheath. After advance to lesion with 5 Fr head-hunter catheter, 0.014 inch Choice-PT wire with 6 Fr Export aspiration catheter was passed the lesion successfully. We changed guidewire into 0.014 inch 300cm Flexicut-wire. Prediation with RIDER 4.0 * 40mm balloon was performed. (Figure 5, Figure 6, Figure 7) Sequentially, balloon expandable Express 7.0 * 37 mm stent was deployed.(Figure 8) Post-stent balloon dilation with stent balloon upto 7.0 (6 atm) was performed.(Figure 9) Final angiogram showed well-positioned stent in both CIAs.(Figure 10)

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