July 7, 2015
Midterm and Long-Term Outcomes Evaluated for Endovascular Treatment for Atherosclerotic Aortic Arch Branch Origin Obstruction
July 8, 2015—Findings from a study that evaluated midterm and long-term results of endovascular treatment of atherosclerotic obstruction of aortic arch branch origins (AABOs) were published by Maarten A.J. van de Weijer, MD, et al in the European Journal of Vascular and Endovascular Surgery (EJVES; 2015;50:13–20). The background of the retrospective cohort study is that endovascular treatment of AABOs has largely replaced open surgery, but long-term outcome data are lacking, stated the investigators.
As summarized in EJVES, the study was composed of patients who underwent endovascular treatment for symptomatic atherosclerotic stenosis of AABO between 1995 and 2012. There were 144 lesions in 114 patients (75 women; mean age, 66.3 years) treated by percutaneous transluminal angioplasty (PTA) in 20 patients and PTA plus stenting in 117 patients (brachiocephalic artery [BCA], 9/54; left common carotid artery [LCCA], 0/7; left subclavian artery [LSA], 11/56). In four patients, the lesion could not be passed, and in three patients, the intervention was terminated before angioplasty.
Technical success was defined as uncomplicated revascularization and residual stenosis ≤ 30%. The primary endpoint was freedom from restenosis ≥ 50% on duplex ultrasonography or magnetic resonance angiography. Secondary endpoints were freedom from target lesion revascularization or recurrent symptoms.
The investigators reported that the 30-day technical success was 94.4%, without deaths or strokes. Mean follow-up was 52 months (range, 2–163 months). Restenosis-free survival was 95.6%, 92.9%, 87.6%, and 83.2% at 12, 24, 48, and 60 months, respectively. Log-rank test showed no significant difference between PTA only and PTA with additional stent placement at any point (P = .375), nor between BCA (n = 51), LCCA (n = 6), or LSA (n = 57). During follow-up, 27 patients (23.7%) became symptomatic (15 BCA, one LCCA, and 11 LSA), including 19 patients with a restenosis of the target lesion (mean, 56.7 months). Symptom-free survival was 94.7%, 92%, 82.3%, and 77.9% at 12, 24, 48, and 60 months, respectively.
The results demonstrate that endovascular treatment of AABO obstruction is safe and effective in experienced hands and can be considered as the preferred treatment with good midterm durability; additionally, recurrent symptomatic lesions can be treated safely by renewed endovascular means, concluded the investigators in EJVES.