Distal embolization due to atherothrombotic debris during subclavian artery interventions is extremely rare and can usually be managed conservatively. Herein, we describe a case of acute hand ischemia due to massive distal embolization during balloon angioplasty and stenting of a left subclavian artery chronic total occlusion. This limb-threatening complication was effectively treated with rescue surgical thrombectomy.
BosiersMDelooseKVerbistJPeetersP. The impact of embolic protection device and stent design on the outcome of CAS. Perspect Vasc Surg Endovasc Ther. 2008;20(3):272–279.
2.
CooperCHallerSColyerW. Embolic protection and platelet inhibition during renal artery stenting. Circulation. 2008;117(21):2752–2760.
3.
EsparzaMSarodeKAtifM. Incidence, Predictors, Management, and Prevention of Distal Embolization During Endovascular Therapy for Infrainguinal Peripheral Arterial Disease. Cathet Cardiovasc Interv. 2015;85(2):s44–s45.
4.
RazaviMK. Detection and treatment of acute thromboembolic events in the lower extremities. Tech Vasc Interv Radiol. 2011;14(2):80–85.
5.
Al-MubarakNLiuMDeanLAl-ShaibiKChastainHIILyerS. Immediate and late outcomes of subclavian artery stenting. Catheter Cardiovasc Interv. 1999;46(2):169–172.
6.
AmorMEid-LidtGChatiZWilentzJR. Endovascular treatment of the subclavian artery: stent implantation with or without predilatation. Catheter Cardiovasc Interv. 2004;63(3):364–370.
7.
BergerLBouzianeZFelisazACoffinODugueAMaizaD. Long-term results of 81 prevertebral subclavian artery angioplasties: a 26-year experience. Ann Vasc Surg. 2011;25(8):1043–1049.
8.
BrountzosENPetersenBBinkertCPanagiotouIKaufmanJA. Primary stenting of subclavian and innominate artery occlusive disease: a single center’s experience. Cardiovasc Intervent Radiol. 2004;27(6):616–623.
9.
De VriesJPJagerLCVan den BergJC. Durability of percutaneous transluminal angioplasty for obstructive lesions of proximal subclavian artery: long-term results. J Vasc Surg. 2005;41(1):19–23.
10.
LinniKUgurluogluAMaderNHitzlWMagometschniggHHolzenbeinTJ. Endovascular management versus surgery for proximal subclavian artery lesions. Ann Vasc Surg. 2008;22(6):769–775.
11.
PalchikEBakkenAMWolfordHYSaadWEDaviesMG. Subclavian artery revascularization: an outcome analysis based on mode of therapy and presenting symptoms. Ann Vasc Surg. 2008;22(1):70–78.
12.
PatelSNWhiteCJCollinsTJ. Catheter-based treatment of the subclavian and innominate arteries. Catheter Cardiovasc Interv. 2008;71(7):963–968.
13.
PrzewlockiTKablak-ZiembickaAPieniazekP. Determinants of immediate and long-term results of subclavian and innominate artery angioplasty. Catheter Cardiovasc Interv. 2006;67(4):519–526.
14.
Rodriguez-LopezJAWernerAMartinezRTorruellaLJRayLIDiethrichEB. Stenting for atherosclerotic occlusive disease of the subclavian artery. Ann Vasc Surg. 1999;13(3):254–260.
15.
SixtSRastanASchwarzwalderU. Results after balloon angioplasty or stenting of atherosclerotic subclavian artery obstruction. Catheter Cardiovasc Interv. 2009;73(3):395–403.
16.
van de WeijerMAVonkenEJde VriesJPMollFLVosJAde BorstGJ. Technical and Clinical Success and Long-Term Durability of Endovascular Treatment for Atherosclerotic Aortic Arch Branch Origin Obstruction: Evaluation of 144 Procedures. Eur J Vasc Endovasc Surg. 2015;50(1):13–20.
17.
ShadmanRCriquiMHBundensWP. Subclavian artery stenosis: prevalence, risk factors, and association with cardiovascular diseases. J Am Coll Cardiol. 2004;44(3):618–623.
18.
MakamP. Evaluating embolic reduction techniques concurrent to infrainguinal interventions: a single-center experience. J Invasive Cardiol. 2014;26(6):277–282.
19.
KobayashiTFunatsuAEjimaE. The results of a new distal protection method in intervention for chronic total occlusion of the superficial femoral artery. Cardiol Res Pract. 2009;2009:687609.
20.
ShammasNWCoinerDShammasGADippelEJChristensenLJerinM. Percutaneous lower-extremity arterial interventions with primary balloon angioplasty versus Silverhawk atherectomy and adjunctive balloon angioplasty: randomized trial. J Vasc Interv Radiol. 2011;22(9):1223–1228.
21.
WoosterMKlodaDRobisonJ. Flow control technique to prevent distal embolization during mechanical thrombectomy. J Vasc Surg. 2012;56(5):1457–1460.
22.
WholeyM. The role of embolic protection in peripheral arterial atherectomy. Tech Vasc Interv Radiol. 2011;14(2):65–74.
23.
TurgemanYSuleimanKFeldmanABushariLI. Transradial diagnosis and intervention of supraaortic vessels. J Invasive Cardiol. 2013;25(6):300–303.
24.
GaoFLoWJSunX. Selective use of transradial access for endovascular treatment of severe intracranial vertebrobasilar artery stenosis. Clin Neurol Neurosurg. 2015;134:116–121.
