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Original article
peer-reviewed

Treatment-Related Cardiovascular Outcomes in Patients with Symptomatic Subclavian Artery Stenosis



Abstract

Background

Subclavian artery stenosis (SAS) is narrowing of the subclavian artery most commonly caused by atherosclerosis. It serves as a marker for cerebrovascular and myocardial ischemic events.

Methods

A retrospective cohort study was conducted to determine the association of treatment via combination therapy (antiplatelet drug plus either by-pass surgery or percutaneous transluminal angioplasty (PTA) with or without stent implantation) versus antiplatelet drug therapy alone on cardiovascular events and all-cause mortality in Marshfield Clinic patients diagnosed with symptomatic SAS from January 1, 1995 to December 31, 2009.

Results

Of the total 2153 cases, 100 patients were identified as eligible to be included in the study. Of these 100 patients that met inclusion criteria, 30 underwent combination therapy while 70 were managed only with drug treatment. A median length of follow-up was 8.45 years. Adverse cardiovascular events occurred in 5/30 (17%) of combination therapy patients compared to 28/70 (40%) of antiplatelet drug therapy only patients (p = 0.0355). Accordingly, all-cause mortality was higher (47%) in the antiplatelet drug therapy only group than the combination therapy group (13%) [hazard ratio = 3.45, p = 0.0218].

Conclusions

Preliminary findings in this pilot data set suggest that combination therapy (medications plus either surgical or interventional repair) of subclavian artery stenosis is associated with less cardiovascular adverse events and higher survival rates. However, prospective randomized studies with larger number of patients are needed to validate these findings.



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Original article
peer-reviewed

Treatment-Related Cardiovascular Outcomes in Patients with Symptomatic Subclavian Artery Stenosis


Author Information

Narendranath Epperla

Hematology and Oncology, Medical College of Wisconsin

Fan Ye

GME Internal Medicine Residency Program, North Florida Regional Medical Center

Amr Idris

GME Internal Medicine Residency Program, North Florida Regional Medical Center

Adeeb Sakkalaek

GME Internal Medicine Residency Program, North Florida Regional Medical Center

Hong Liang

GME Internal Medicine Residency Program, North Florida Regional Medical Center

Cyberknife at North Florida

Po-Huang Chyou

Biomedical Informatics Research Center, Marshfield Clinic Research Foundation

Richard A. Dart

Center for Human Genetics, Marshfield Clinic Research Foundation

Joseph Mazza

Department of Clinical Research, Marshfield Clinic Research Foundation

Steven Yale Corresponding Author

Internal Medicine, University of Central Florida College of Medicine


Ethics Statement and Conflict of Interest Disclosures

Human subjects: Consent was obtained by all participants in this study. Marshfield Clinic Research Foundation IRB issued approval. Informed consent obtained. Animal subjects: This study did not involve animal subjects or tissue. Conflicts of interest: The authors have declared that no conflicts of interest exist.

Acknowledgements

The authors would like to thank Dr. Hale Toklu from North Florida Regional Medical Center Department of Graduate Medical Education, for her contribution in reviewing the manuscript. Funding Source: Funding for this study was provided by the Marshfield Clinic Resident Research Funds.


Original article
peer-reviewed

Treatment-Related Cardiovascular Outcomes in Patients with Symptomatic Subclavian Artery Stenosis


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Original article
peer-reviewed

Treatment-Related Cardiovascular Outcomes in Patients with Symptomatic Subclavian Artery Stenosis

  • Author Information
    Narendranath Epperla

    Hematology and Oncology, Medical College of Wisconsin

    Fan Ye

    GME Internal Medicine Residency Program, North Florida Regional Medical Center

    Amr Idris

    GME Internal Medicine Residency Program, North Florida Regional Medical Center

    Adeeb Sakkalaek

    GME Internal Medicine Residency Program, North Florida Regional Medical Center

    Hong Liang

    GME Internal Medicine Residency Program, North Florida Regional Medical Center

    Cyberknife at North Florida

    Po-Huang Chyou

    Biomedical Informatics Research Center, Marshfield Clinic Research Foundation

    Richard A. Dart

    Center for Human Genetics, Marshfield Clinic Research Foundation

    Joseph Mazza

    Department of Clinical Research, Marshfield Clinic Research Foundation

    Steven Yale Corresponding Author

    Internal Medicine, University of Central Florida College of Medicine


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: Consent was obtained by all participants in this study. Marshfield Clinic Research Foundation IRB issued approval. Informed consent obtained. Animal subjects: This study did not involve animal subjects or tissue. Conflicts of interest: The authors have declared that no conflicts of interest exist.

    Acknowledgements

    The authors would like to thank Dr. Hale Toklu from North Florida Regional Medical Center Department of Graduate Medical Education, for her contribution in reviewing the manuscript. Funding Source: Funding for this study was provided by the Marshfield Clinic Resident Research Funds.


    Article Information

    Published: May 19, 2017

    DOI

    10.7759/cureus.1262

    Cite this article as:

    Epperla N, Ye F, Idris A, et al. (May 19, 2017) Treatment-Related Cardiovascular Outcomes in Patients with Symptomatic Subclavian Artery Stenosis. Cureus 9(5): e1262. doi:10.7759/cureus.1262

    Publication history

    Received by Cureus: May 03, 2017
    Peer review began: May 04, 2017
    Peer review concluded: May 09, 2017
    Published: May 19, 2017

    Copyright

    © Copyright 2017
    Epperla et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Background

Subclavian artery stenosis (SAS) is narrowing of the subclavian artery most commonly caused by atherosclerosis. It serves as a marker for cerebrovascular and myocardial ischemic events.

Methods

A retrospective cohort study was conducted to determine the association of treatment via combination therapy (antiplatelet drug plus either by-pass surgery or percutaneous transluminal angioplasty (PTA) with or without stent implantation) versus antiplatelet drug therapy alone on cardiovascular events and all-cause mortality in Marshfield Clinic patients diagnosed with symptomatic SAS from January 1, 1995 to December 31, 2009.

Results

Of the total 2153 cases, 100 patients were identified as eligible to be included in the study. Of these 100 patients that met inclusion criteria, 30 underwent combination therapy while 70 were managed only with drug treatment. A median length of follow-up was 8.45 years. Adverse cardiovascular events occurred in 5/30 (17%) of combination therapy patients compared to 28/70 (40%) of antiplatelet drug therapy only patients (p = 0.0355). Accordingly, all-cause mortality was higher (47%) in the antiplatelet drug therapy only group than the combination therapy group (13%) [hazard ratio = 3.45, p = 0.0218].

Conclusions

Preliminary findings in this pilot data set suggest that combination therapy (medications plus either surgical or interventional repair) of subclavian artery stenosis is associated with less cardiovascular adverse events and higher survival rates. However, prospective randomized studies with larger number of patients are needed to validate these findings.



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Create a free account to continue reading this article.

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Narendranath Epperla

Hematology and Oncology, Medical College of Wisconsin

Fan Ye

GME Internal Medicine Residency Program, North Florida Regional Medical Center

Amr Idris

GME Internal Medicine Residency Program, North Florida Regional Medical Center

Adeeb Sakkalaek

GME Internal Medicine Residency Program, North Florida Regional Medical Center

Hong Liang

GME Internal Medicine Residency Program, North Florida Regional Medical Center

Po-Huang Chyou

Biomedical Informatics Research Center, Marshfield Clinic Research Foundation

Richard A. Dart

Center for Human Genetics, Marshfield Clinic Research Foundation

Joseph Mazza

Department of Clinical Research, Marshfield Clinic Research Foundation

Steven Yale

Internal Medicine, University of Central Florida College of Medicine

For correspondence:
steven.yale.md@gmail.com

Narendranath Epperla

Hematology and Oncology, Medical College of Wisconsin

Fan Ye

GME Internal Medicine Residency Program, North Florida Regional Medical Center

Amr Idris

GME Internal Medicine Residency Program, North Florida Regional Medical Center

Adeeb Sakkalaek

GME Internal Medicine Residency Program, North Florida Regional Medical Center

Hong Liang

GME Internal Medicine Residency Program, North Florida Regional Medical Center

Po-Huang Chyou

Biomedical Informatics Research Center, Marshfield Clinic Research Foundation

Richard A. Dart

Center for Human Genetics, Marshfield Clinic Research Foundation

Joseph Mazza

Department of Clinical Research, Marshfield Clinic Research Foundation

Steven Yale

Internal Medicine, University of Central Florida College of Medicine

For correspondence:
steven.yale.md@gmail.com