Long-term outcomes of patients with subclavian artery stenosis or occlusion after endovascular treatment

ABSTRACT Objective To evaluate the long-term safety, efficacy, and prognosis of endovascular treatment in patients with subclavian artery stenosis or occlusion (SAS/SAO). Methods This single-center, retrospective study analyzed 232 consecutive patients undergoing endovascular treatment for SAS/SAO between June 2017 and June 2024. The endpoints included technical success, complication rate and freedom from cardiovascular death (CVD), restenosis, and re-intervention. Multivariable analysis was performed to determine independent predictors. Results Technical success rate was significantly higher in stenoses than in occlusions (99.4% versus 90.8%, p < .001). The perioperative complication rate was 5.2%. Over a mean follow-up of 48.2 months, freedom from CVD, restenosis and re-intervention were 97.1%, 89.1% and 97.0% at five years, 88.7%, 77.7% and 89.0% at seven years, respectively. Predictors (HR, 95% CI, p) of CVD included upper limb ischemia (6.845, 1.108-42.301, p=.038), age (1.148, 1.001-1.316, p=.048), and prior coronary revascularization (8.683, 1.311-57.511, p=.025). Predictors of restenosis included upper limb ischemia (2.408, 1.007-5.757, p=.048) and smaller stent diameter (0.665, 0.461-0.958, p=.029). For re-intervention, predictors included transbrachial access (3.494, 1.278-9.551, p=.015) and right-sided lesion (6.080, 1.457-25.376, p=.013). Conclusion Endovascular treatment is a safe and effective revascularization strategy for subclavian artery stenosis or occlusion, demonstrating favorable long-term patency and low complication rate. The study identifies risk factors for CVD, restenosis and re-intervention, which may benefit the management for patients at risk.