Subclavian artery stenosis can be cured in a quarter of an hour. Do you know about stent interventional treatment?

Author: Li Qingle, Chief Physician, Peking University People's Hospital

Reviewer: Chen Zhong, Chief Physician, Beijing Anzhen Hospital, Capital Medical University

With the rapid development of interventional technology, interventional treatment of subclavian artery stenosis has become a routine procedure in clinical practice.

A guide wire and catheter are used to pass through the narrow lesion, and then after dilation with a balloon, a stent is placed to maintain the diameter of the lumen, so that blood flow can be improved.

Figure 1 Original copyright image, no permission to reprint

For experienced treatment centers, the opening rate of interventional treatment is very high and can bring great benefits to patients.

In terms of operation time, if it is a stenotic lesion that is not completely occluded, it may be completed within 10-30 minutes. Because guidewires and catheters can easily pass through narrow blood vessels, we only use balloons for pre-expansion, and then select appropriate stents with balloons for local positioning and release. This process may be relatively fast and may be completed in about a quarter of an hour. Therefore, it has much greater advantages than general anesthesia and extra-anatomical bypass.

However, if it is an occlusive lesion, that is, the condition is more serious, the development time is longer, and the occluded segment is also longer, opening may be a very important step. Because in the thoracic segment, the opening operation needs to be more delicate, and then it must be based on experience to avoid complications, so at this time, opening is the longest part of the entire operation. It may not be possible to open the complicated one or two hours, including upper limb access, aortic access, and bidirectional access. Some plaques are particularly hard and may not be opened, and finally may be converted to elective bypass surgery.

So actually it is mainly about opening up the occluded lesions and then placing stents. It will be relatively fast, but most operations can be completed in about an hour. Of course, if the lesion is not resolved in 1 hour, it is very likely that it will not be resolved in 2 hours.

That is to say, the probability of opening is not necessarily proportional to time. If the nature of the lesion is such, there is no need to let the patient spend more time and take greater risks. Generally speaking, experienced centers will stop at the right time. Because we also have a risk-controlled extra-anatomical bypass surgery that can also solve the problem, including bypass from one axillary artery to the other axillary artery, and also from the carotid artery to the subclavian artery. These can all be done. This is a backup surgical plan after the intervention is unsuccessful.

Strictly speaking, patients who undergo stent interventional treatment for subclavian artery stenosis can be discharged from the hospital 24 hours after the operation. For example, if the operation is completed today, patients may be able to get out of bed in the evening or the next day, and then arrange to walk the next day. Most patients can be discharged from the hospital within two or three days from the operation.

In fact, day surgery has become a trend now, where patients come and leave on the same day, but the risks involved must be assessed.

If the patient is assessed to have no risks, he or she can indeed get out of bed and walk on the same day. This is not impossible. There is a trend towards day surgery for many lower limb lesions, which shows that our technical means are more minimally invasive and safer.

Of course, some patients may worry about allergic or rejection reactions to stent intervention for subclavian artery stenosis.

In fact, in the past, the composition and material of stents were mostly stainless steel, and some people were allergic to this material, but it was basically a transient reaction. Now, nickel-titanium alloy is more commonly used, and relatively speaking, the possibility of allergies is relatively less.

Rejection actually does not exist. Because the stent is made of metal, it has no immune effect on the human body. It is different from some of the biological materials we use, and it has no immunogenicity.

Figure 2 is an original copyrighted image and is not authorized for reproduction

But since it is a metal foreign body, some individuals may have an allergic reaction to it. We can see that the instructions for use of each product include a careful screening process.

Of course, there is also a problem, that is, many patients may not know whether they are allergic to nickel-titanium alloy. Of course, people who are allergic to stainless steel may know that they will be allergic if they wear a stainless steel bracelet, but these situations need to be carefully screened and the appropriate material should be selected according to their physical constitution.

Of course, another reaction is the stimulation of metal foreign bodies in blood vessels, especially for young patients. This stimulation of metal foreign bodies can cause local proliferative reactions and cause local restenosis. The younger the patient, the higher the risk of restenosis caused by local stimulation.

Another point that patients need to pay attention to is that after stent intervention to treat subclavian artery stenosis, basic treatment measures cannot be stopped.

You may also know that after a stent is placed in a coronary heart disease patient, the peripheral vascular diseases, including many circulatory system lesions, actually require continuous medication to control the underlying disease, such as internal medicine diseases, blood pressure, blood sugar, blood lipids, and lifestyle habits. These conservative plans will continue for a lifetime.

Some other drugs are special, such as antiplatelet drugs after blood circulation is reestablished, because antiplatelet drugs in the arterial system are more important. Now, they are also referring to the medication method after coronary stenting. Maybe within six months, two antiplatelet drugs should be taken orally, including aspirin, clopidogrel, and cilostazol commonly used in vascular surgery, etc.

After half a year, the local scar reaction or platelet aggregation reaction will weaken, and then you can switch to one, or even two antiplatelet drugs for a year or long term. Especially in the lower limbs, the medication time is determined according to the microcirculation situation, and sometimes the antiplatelet drug can be used for a longer time.