In Reply to: 597 02 -- Subclavian artery stent in a CABG patient posted by Editor on May 15, 1997 at 17:03:08:
Clinically evident embolization to the arm occurs during 1-1.5% of subclavian PTA's. The true incidence is likely higher, since small emboli to the forearm are usually clinically silent. in patients with a LIMA graft, even a small embolic event could be fatal. therefore it is essential to maximize outflow to the arm during subclavian PTA. For this reason, dilating the distal stenosis first was key. Vasodilation of the arm shouldbe induced prior to the PTA proximal to the LIMA.
Precision stent placement is also critical in these cases to avoid covering the origin of the verebral artery. This is more easily accomplished with A PALMAZ stent than a Wallstent.