Intervention Review

You have free access to this content

Angioplasty versus stenting for subclavian artery stenosis

  1. Wagner Iared1,
  2. José Eduardo Mourão2,*,
  3. Andrea Puchnick2,
  4. Fernando Soma2,
  5. David Carlos Shigueoka3

Editorial Group: Cochrane Peripheral Vascular Diseases Group

Published Online: 16 MAY 2014

Assessed as up-to-date: 25 FEB 2014

DOI: 10.1002/14651858.CD008461.pub3


How to Cite

Iared W, Mourão JE, Puchnick A, Soma F, Shigueoka DC. Angioplasty versus stenting for subclavian artery stenosis. Cochrane Database of Systematic Reviews 2014, Issue 5. Art. No.: CD008461. DOI: 10.1002/14651858.CD008461.pub3.

Author Information

  1. 1

    Universidade Federal de São Paulo, Brazilian Cochrane Centre, Department of Internal Medicine, São Paulo, São Paulo, Brazil

  2. 2

    Universidade Federal de São Paulo, Department of Diagnostic Imaging, São Paulo, Brazil

  3. 3

    Universidade Federal de São Paulo, São Paulo, Brazil

*José Eduardo Mourão, Department of Diagnostic Imaging, Universidade Federal de São Paulo, São Paulo, Brazil. ze_eduardomourao@terra.com.br.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 16 MAY 2014

SEARCH

 

Background

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. Contributions of authors
  13. Declarations of interest
  14. Sources of support
  15. Index terms
 

Description of the condition

Arterial reconstruction is less frequently performed in the upper limbs than in the lower limbs, probably because of the lower muscular mass, rich collateral circulation and the lesser burden of the weight carried by the upper limbs compared with the lower limbs. The prevalence of subclavian artery stenosis in the general population is estimated at approximately 2%. In a clinical population (that is patients recruited from vascular laboratories or medical institutions) the prevalence is about 7% (Shadman 2004).

Subclavian artery stenosis may be asymptomatic. When symptoms occur they are mainly due to vertebrobasilar insufficiency (that is decreased blood flow in the posterior circulation of the brain), upper limb ischaemia, or both.

A history of smoking, higher levels of systolic blood pressure, lower levels of high density lipoprotein cholesterol and the presence of peripheral arterial diseases are associated with an increased risk of subclavian artery stenosis (Shadman 2004).

 

Description of the intervention

Bachman et al (Bachman 1980) reported the first case of successful subclavian angioplasty. Lyon et al suggested that the placement of metallic stents in supra-aortic arteries represented an effective adjunct to percutaneous balloon angioplasty of atherosclerotic stenosis in these vessels, and that primary stent placement may be an effective treatment for selected lesions (Lyon 1996).

 

How the intervention might work

Elastic recoil of the vessel wall is a common cause of failure of percutaneous transluminal angioplasty. Expandable metal stents are used to oppose such recoil (Palmaz 1987).

 

Why it is important to do this review

There is insufficient evidence to guide stent usage following angioplasty in subclavian artery stenosis. This review will address effectiveness and safety issues that could help with establishing practical guidelines.

 

Objectives

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. Contributions of authors
  13. Declarations of interest
  14. Sources of support
  15. Index terms

The aim of this review was to determine whether stenting is more effective than angioplasty alone for stenosis of the subclavian artery.

 

Methods

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. Contributions of authors
  13. Declarations of interest
  14. Sources of support
  15. Index terms
 

Criteria for considering studies for this review

 

Types of studies

Randomised controlled trials (RCTs) comparing stenting and angioplasty for stenosis of the subclavian artery. We considered trials that had been published in full or had results presented in abstract form. We included abstracts only if there were sufficient data for analysis or there were plans for full publication, or the authors had available unpublished data on file for review and analysis. In addition, we considered randomised trials conducted by the stent device manufacturers (on file but not published). There was no restriction on language.

 

Types of participants

We planned for the studies selected for review to include:

  • men and women with an indication for revascularization of the subclavian artery (stenosis > 70%);
  • patients with symptomatic subclavian artery or brachiocephalic trunk disease; claudication of the upper limb or vertebrobasilar insufficiency, or both;
  • patients with symptomatic coronary-subclavian steal syndrome;
  • patients with documented occlusions or stenoses of the subclavian artery or brachiocephalic trunk (diagnosed by duplex ultrasound scan or angiogram);
  • patients with lesions who were allocated to treatment with balloon angioplasty or stenting;
  • patients receiving medical therapy for associated pre-morbid conditions e.g. diabetes mellitus, hyperlipidaemia or hypertension, pre- or post-intervention (e.g. antiplatelets, antihypertensive drugs, lipid-lowering drugs);
  • patients receiving anticoagulation pre- or post-intervention (e.g. heparin or warfarin);
  • patients not receiving any medical or anticoagulation therapy.

 

Types of interventions

The primary interventions of interest were angioplasty without a stent and the use of stents after restoration of patency in occlusions or stenoses of the subclavian artery or brachiocephalic trunk that is primary stenting.

We planned to include interventional studies fulfilling the following criteria:

  • studies in which stenting was done for secondary purposes i.e. to treat post-angioplasty vessel wall dissections;
  • studies using balloon angioplasty techniques to restore patency (transluminal or subintimal);
  • studies including various types of stent and configuration e.g. uncovered or covered, steel or reinforced nitinol, drug eluting or simple stents.

 

Types of outcome measures

 

Primary outcomes

We planned to analyse the following primary outcome.

  1. Vessel patency rate i.e. restenosis or re-occlusion rates, both primary and secondary, including duration to restenosis or re-occlusion as defined by an imaging modality such as duplex ultrasound, magnetic resonance angiography or computed tomography angiography.

 

Secondary outcomes

We planned to analyse the following secondary outcomes.

  1. Improvement of symptoms i.e. disappearance of the symptoms of upper limb claudication or vertebrobasilar insufficiency, or both.
  2. Follow up of restenosis (1, 6,12 months or longer).

We planned for the secondary outcomes to include the following.

  1. Decrease in the difference of blood pressure between the upper limbs post-treatment.
  2. Morbidity rates: (a) stent related - stent failure or fracture, stent migration, stent infection, stent occlusion; (b) procedural related - groin or brachial hematoma, wound infection, wound bleeding, vessel rupture or perforation, vessel wall dissection, distal emboli; (c) general morbidity - development of acute myocardial infarction, acute renal failure, chronic renal failure, or cerebrovascular events.
  3. Mortality at 30 days, one year, and two years.
  4. Measures of efficacy such as quality of life scores at 30 days, one year, and two years.

We planned to perform subgroup analyses of patients stratified by the following factors.

  1. Stent types: drug eluting versus non-drug eluting, steel versus reinforced (nitinol), covered (PTFE) versus uncovered.
  2. Stent location: brachiocephalic trunk versus subclavian artery stenting.

 

Search methods for identification of studies

 

Electronic searches

For this update the Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator (TSC) searched the Specialised Register (last searched February 2014) and the Cochrane Central Register of Controlled Trials (CENTRAL) 2014, Issue 1, part of The Cochrane Library, (www.thecochranelibrary.com). See Appendix 1 for details of the search strategy used to search CENTRAL. The Specialised Register is maintained by the TSC and is constructed from weekly electronic searches of MEDLINE, EMBASE, CINAHL, AMED, and through handsearching relevant journals. The full list of the databases, journals and conference proceedings which have been searched, as well as the search strategies used are described in the Specialised Register section of the Cochrane Peripheral Vascular Diseases Group module in The Cochrane Library (www.thecochranelibrary.com).

In addition, the authors searched the following electronic databases.

  1. Ovid MEDLINE® (1946 to February Week 2 2014), see Appendix 2 for the search strategy.
  2. Ovid EMBASE (1980 to Week 08, 2014), see Appendix 3 for the search strategy.
  3. LILACS (1985 to 10 April 2014), see Appendix 4 for the search strategy.

 

Data collection and analysis

 

Selection of studies

Two review authors (AP and JEM) independently evaluated studies to assess eligibility. Discrepancies were resolved by discussion. If there was no agreement, a third review author (FS) was asked to assess the study for inclusion.

 

Data extraction and management

We intended that three review authors would extract data from published reports using a data collection form. We intended to resolve disagreements by consensus.

We intended to extract the following data.

  1. The method of randomisation and whether the person undertaking the randomisation was blinded to the allocated treatment.
  2. The number of patients originally allocated to each treatment group, to allow an intention-to-treat analysis.
  3. The method of measuring outcomes and whether outcome assessment was independent or blinded, or both.
  4. The number of exclusions and losses to follow-up.
  5. Intervention characteristics.
  6. Outcome measures, as defined above.

We also planned to extract the following data to allow a number of subgroup analyses.

  1. The proportion of symptomatic versus asymptomatic patients in each treatment group.
  2. The degree of baseline stenosis in each treatment group.

 

Assessment of risk of bias in included studies

We planned to assess risk of bias of the included studies using the Cochrane risk of bias tool (Higgins 2011) assessing sequence generation; allocation concealment; blinding of participants, providers and outcome assessors; completeness of outcome data; selective outcome reporting; and other potential sources of bias. Three review authors planned to assess these domains by assigning a judgement of either low, high or unclear risk of bias according to Higgins 2011. We planned to resolve disagreements by consensus.

 

Measures of treatment effect

We intended to use the following measures for the effect of treatment.

  1. For time-to-event data, we would use the hazard ratio, if possible.
  2. For dichotomous outcomes, we would use the odds ratio (OR).
  3. For continuous outcomes, we would use the mean difference between treatment arms.

We intended to report the results as OR with 95% confidence intervals (CI), which we planned to calculate using the Peto fixed-effect model method. In view of expected heterogeneity between trials, we also planned to calculate the OR using the Mantel-Haenszel random-effects model. We intended to use P = 0.05 as the level of significance.

 

Unit of analysis issues

We planned to individually analyse each cluster-randomised trial before deciding whether or not to include it in the review. Because of the nature of the procedures involved, it was not expected that there would be any cross-over trials. In studies with multiple treatment groups, we planned to assess the possibility of including the subgroups with the interventions of interest.

 

Dealing with missing data

We did not plan to impute missing outcome data for the primary outcome. If, in future updates of this review, data are missing or only imputed data are reported, we plan to contact the trial authors to request data on the outcomes only for those participants who were assessed.

 

Assessment of heterogeneity

We planned to assess heterogeneity between studies by visual inspection of forest plots; by estimation of the percentage heterogeneity between trials which could not be ascribed to sampling variation (Higgins 2003); by a formal statistical test of the significance of the heterogeneity (Deeks 2001) using a standard Chi2 test with P = 0.1 as the level of significance; and, if possible, by subgroup analyses (see below). We planned to investigate and report the possible reasons where there was evidence of substantial heterogeneity.

 

Assessment of reporting biases

We planned to examine funnel plots corresponding to the meta-analysis of the primary outcome to assess the potential for small study effects such as publication bias.

 

Data synthesis

If sufficient clinically similar studies were available, we planned to pool their results in a meta-analysis.

  1. For time-to-event data, hazard ratios would be pooled using the generic inverse variance facility of RevMan 5.
  2. For any dichotomous outcomes, the OR would be calculated for each study and these would then be pooled.
  3. For continuous outcomes, the mean difference between the treatment arms at the end of follow up would be pooled if all trials measured the outcome on the same scale, otherwise standardised mean differences would be pooled.

If any trials had multiple treatment groups, we planned to divide the 'shared' comparison group into the number of treatment groups and comparisons between each treatment group and we planned to treat the split comparison group as an independent comparison.

We planned to use random-effects models with inverse variance weighting for all meta-analyses (DerSimonian 1986).

If possible, we would synthesize the studies making different comparisons using the methods of Bucher (Bucher 1997).

 

Subgroup analysis and investigation of heterogeneity

We intended to perform subgroup analyses, grouping the trials by:

  • symptomatic and asymptomatic patients in each treatment group;
  • degree of baseline stenosis in each treatment group.

We planned to consider factors such as age, clinical stage, type of intervention, length of follow up, adjusted or unadjusted analysis in the interpretation of any heterogeneity.

 

Sensitivity analysis

We planned to perform sensitivity analyses by excluding studies at high risk of bias.

If sufficient trials were available, we also planned to performed sensitivity analyses by excluding studies which did not report adequate concealment of allocation or blinding of the outcome assessor.

 

Results

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. Contributions of authors
  13. Declarations of interest
  14. Sources of support
  15. Index terms
 

Description of studies

 

Results of the search

See Figure 1.

 FigureFigure 1. Study flow diagram.

 

Included studies

We did not find any randomised controlled trials, therefore no studies were included in the review.

 

Excluded studies

For this update an additional five studies were excluded (Angle 2003; De Vries 2005; Mathias 1993; Motarjeme 1996; Westerband 2003) and two additional citations were added to a study which had previously been excluded (Henry 1999).

In total eight studies were excluded (Angle 2003; De Vries 2005; Henry 1999; Mathias 1993; Motarjeme 1996; Schillinger 2001; Sixt 2009; Westerband 2003). All were comparative observational studies comparing results of PTA and stenting for subclavian artery stenosis.

 

Risk of bias in included studies

There are no included studies.

 

Effects of interventions

Results based on RCTs were not available as no RCTs were identified. Information regarding whether stenting is more effective than angioplasty alone for stenosis of the subclavian artery is currently based on observational studies only.

 

Discussion

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. Contributions of authors
  13. Declarations of interest
  14. Sources of support
  15. Index terms
 

Summary of main results

There are no randomised controlled trials (RCTs) to support that stenting is better than angioplasty alone for subclavian artery stenosis.

 

Overall completeness and applicability of evidence

The studies that assessed the interventions, outcomes and types of participants of interest to this review were not randomised controlled trials. Therefore there is a lack of evidence to support changes in current practice.

 

Quality of the evidence

The best evidence regarding whether stenting is more effective than angioplasty alone for stenosis of the subclavian artery stems from retrospective observational studies. This type of study presents biases inherent in non-randomised studies.

 

Potential biases in the review process

Although we have conducted extensive literature searches only observational studies were identified.

 

Agreements and disagreements with other studies or reviews

Despite the absence of randomised controlled trials, there have been publications of observational studies comparing angioplasty and stenting for subclavian artery lesions (Angle 2003; De Vries 2005; Henry 1999; Mathias 1993; Motarjeme 1996; Schillinger 2001; Sixt 2009; Westerband 2003. Most of these have been summarised in a systematic review with meta-analysis by Chatterjee 2013.

Chatterjee 2013 also did not find RCTs. Their review included 544 participants of whom 307 underwent angioplasty alone and 237 had stents implanted. The results of the observational studies suggests that stenting after PTA is superior to angioplasty alone for treatment of subclavian artery stenosis and maintenance of patency at one year without significant complication rates for either procedure.

Still, the best evidence regarding whether stenting is more effective than angioplasty alone for stenosis of the subclavian artery stems from retrospective observational studies.

 

Authors' conclusions

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. Contributions of authors
  13. Declarations of interest
  14. Sources of support
  15. Index terms

 

Implications for practice

There is currently insufficient evidence to determine whether stenting is more effective than angioplasty alone for stenosis of the subclavian artery.

 
Implications for research

A randomised controlled trial comparing the two intervention modalities would be desirable. Future research should focus on clinical endpoints, technical endpoints and complications. We envisage that the main clinical endpoints should be improvement of the symptoms of upper limb ischaemia, vertebrobasilar insufficiency and the subclavian steal phenomenon. Complications should include distal embolisation, stroke and transient ischaemic attack and technical endpoints should be assessed by primary and secondary patency, and restenosis or re-occlusion rates in short, mid and long-term (Rodriguez-Lopez 1999; White 2007) follow-up.

 

Acknowledgements

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. Contributions of authors
  13. Declarations of interest
  14. Sources of support
  15. Index terms

We would like to thank Prof Dr Álvaro Nagib Atallah, Dr Edina Mariko Koga da Silva and Dr Marlene Stewart for their guidance, and Dr Karen Welch for her essential assistance in the preparation of strategies for searching the electronic databases.

 

Data and analyses

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. Contributions of authors
  13. Declarations of interest
  14. Sources of support
  15. Index terms

This review has no analyses.

 

Appendices

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. Contributions of authors
  13. Declarations of interest
  14. Sources of support
  15. Index terms
 

Appendix 1. CENTRAL search strategy


#1MeSH descriptor: [Angioplasty] explode all trees4361

#2(angioplas* or percutan* or PTA):ti,ab,kw (Word variations have been searched)10285

#3recanali* or revascular*:ti,ab,kw (Word variations have been searched)5040

#4dilat*:ti,ab,kw (Word variations have been searched)5792

#5balloon or baloon:ti,ab,kw (Word variations have been searched)6059

#6MeSH descriptor: [Endovascular Procedures] explode all trees6017

#7endovascular:ti,ab,kw (Word variations have been searched)935

#8#1 or #2 or #3 or #4 or #5 or #6 or #721464

#9MeSH descriptor: [Blood Vessel Prosthesis] explode all trees452

#10MeSH descriptor: [Blood Vessel Prosthesis Implantation] explode all trees508

#11MeSH descriptor: [Stents] explode all trees3314

#12*stent* or graft* or endograft* or endoprosthe*:ti,ab,kw (Word variations have been searched)45533

#13powerlink or talent or excluder or aorfix or zenith or endologix or anaconda or Triascular or Cordis or Endurant or Quantum or Aneurx or Ancure or Advanta or Intracoil or Zilver or Luminex:ti,ab,kw (Word variations have been searched)292

#14#9 or #10 or #11 or #12 or #1345928

#15#8 and #145618

#16MeSH descriptor: [Subclavian Artery] explode all trees19

#17MeSH descriptor: [Brachiocephalic Trunk] explode all trees3

#18MeSH descriptor: [Brachiocephalic Veins] explode all trees14

#19subclav* or sub-clav*:ti,ab,kw (Word variations have been searched)305

#20brachioceph*:ti,ab,kw (Word variations have been searched)32

#21MeSH descriptor: [Vertebrobasilar Insufficiency] explode all trees46

#22vertebro* near/3 insuff*:ti,ab,kw (Word variations have been searched)79

#23steal:ti,ab,kw (Word variations have been searched)85

#24#16 or #17 or #18 or #19 or #20 or #21 or #22 or #23483

#25#15 and #24 in Trials19



 

Appendix 2. Authors' MEDLINE search strategy

Database: Ovid MEDLINE(R) <1946 to February Week 2 2014>

--------------------------------------------------------------------------------

1 exp Angioplasty/ (53773)

2 Vascular Surgical Procedures/ (23182)

3 Blood Vessel Prosthesis Implantation/ (15107)

4 exp Balloon Dilatation/ (0)

5 exp Stents/ (51225)

6 (angioplasty or stent$ or PTA or revasculari?ation or dilatation or endovascular).ti,ab. (159919)

7 1 or 2 or 3 or 4 or 5 or 6 (203672)

8 arterial occlusive diseases/ or arteriosclerosis/ or arteriolosclerosis/ or arteriosclerosis obliterans/ or atherosclerosis/ (100175)

9 (isch?emia or insufficiency or arteriosclerosis or atherosclerosis or occlus$ or claudic$ or steno$).ti,ab. (504210)

10 8 or 9 (545465)

11 Subclavian Artery/ (6372)

12 Brachiocephalic Trunk/ (2240)

13 Brachiocephalic Veins/ (1252)

14 (subclav$ or sub-clav$).ti,ab. (12695)

15 brachioceph$.ti,ab. (2378)

16 exp Vertebrobasilar Insufficiency/ (4160)

17 (vertebro$ adj3 insuff$).ti,ab. (765)

18 steal.ti,ab. (3131)

19 or/11-18 (23347)

20 7 and 10 and 19 (2437)

 

Appendix 3. Authors' EMBASE search strategy

Database: Ovid EMBASE <1980 to 2014 Week 08>

Database: Embase <1980 to 2014 Week 08>

Search Strategy:

--------------------------------------------------------------------------------

1 exp angioplasty/ (68370)

2 vascular surgery/ (27727)

3 exp blood vessel prosthesis/ (14224)

4 exp balloon dilatation/ (12940)

5 exp stent/ (99626)

6 (angioplasty or stent$ or PTA or revasculari?ation or dilatation or endovascular).ti,ab. (239308)

7 1 or 2 or 3 or 4 or 5 or 6 (310964)

8 exp arteriosclerosis/ (188137)

9 exp peripheral occlusive artery disease/ (116627)

10 (isch?emia or insufficiency or arteriosclerosis or atherosclerosis or occlus$ or claudic$ or steno$*).ti,ab. (672294)

11 8 or 9 or 10 (793215)

12 subclavian artery/ (8725)

13 brachiocephalic trunk/ (3232)

14 brachiocephalic vein/ (1750)

15 (subclav$ or sub-clav$).ti,ab. (16835)

16 brachioceph$.ti,ab. (3255)

17 vertebrobasilar insufficiency/ (2293)

18 (vertebro$ adj3 insuff$).ti,ab. (1025)

19 steal.ti,ab. (3931)

20 12 or 13 or 14 or 15 or 16 or 17 or 18 or 19 (29140)

21 7 and 13 and 20 (874)

 

Appendix 4. Authors' Lilacs search strategy

("vascular surgical procedures") or "blood vessel prosthesis implantation" [Subject descriptor] or ("Balloon Dilatation") or (Stents) or (Stent) or (angioplasty) or (PTA) or (revascularization) or (dilatation) or (endovascular) [Words] and (Subclavian) or ("Subclavian Artery") or ("Brachiocephalic Trunk") or ("Brachiocephalic Veins") or ("Vertebrobasilar Insufficiency") [Words] (68)

 

What's new

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. Contributions of authors
  13. Declarations of interest
  14. Sources of support
  15. Index terms

Last assessed as up-to-date: 25 February 2014.


DateEventDescription

25 February 2014New search has been performedSearches rerun. No new included studies were identified, five additional studies were excluded.

25 February 2014New citation required but conclusions have not changedNew authors have joined the review team. Searches rerun. No new included studies were identified, five additional studies were excluded. Minor changes to the text of the review. Conclusions not changed.



 

Contributions of authors

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. Contributions of authors
  13. Declarations of interest
  14. Sources of support
  15. Index terms

AP and JEM selected trials for inclusion.
DSC and WI assessed methodological quality and extracted data.
FS resolved any disagreements in trial selection, assessed methodological quality and extracted data.
WI and DSC wrote the review.

 

Declarations of interest

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. Contributions of authors
  13. Declarations of interest
  14. Sources of support
  15. Index terms

None known

 

Sources of support

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. What's new
  12. Contributions of authors
  13. Declarations of interest
  14. Sources of support
  15. Index terms
 

Internal sources

  • No sources of support supplied

 

External sources

  • Chief Scientist Office, Scottish Government Health Directorates, The Scottish Government, UK.
    The PVD Group editorial base is supported by the Chief Scientist Office.

References

References to studies excluded from this review

  1. Top of page
  2. AbstractRésumé scientifique
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. Contributions of authors
  14. Declarations of interest
  15. Sources of support
  16. Characteristics of studies
  17. References to studies excluded from this review
  18. Additional references
Angle 2003 {published data only}
  • Angle FJ, Matsumoto AH, McGraw JK, Spinosa DJ, Hagspiel KD, Leung DA, et al. Percutaneous angioplasty and stenting of left subclavian artery stenosis in patients with left internal mammary-coronary bypass grafts: clinical experience and long-term follow-up. Vascular and Endovascular Surgery 2003;37:89-97.
De Vries 2005 {published data only}
  • De Vries JP, Jager LC, Van den Berg JC, Overtoom TT, Ackerstaff RG, Van de Pavoordt ED, et al. Durability of percutaneous transluminal angioplasty for obstructive lesions of proximal subclavian artery: long-term results. Journal of Vascular Surgery 2005;41(1):19-23.
Henry 1999 {published data only}
  • Henry IP, Benjelloun A, Henry MC. Percutaneous transluminal angioplasty of the subclavian arteries. Long-term follow up. Journal of the American College of Cardiology 2013;62(18 Suppl 1):B156.
  • Henry M, Armor M, Henry I, Ethevenot G, Tzvetanov K, Chati Z. Percutaneous transluminal angioplasty of the subclavian arteries. Journal of Endovascular Surgery 1999;6:33-41.
  • Henry M, Hugel M, Henry I, Polydorou A. Percutaneous transluminal angioplasty of the subclavian arteries. Long-term followup. Journal of the American College of Cardiology 2010;56(13):B95.
Mathias 1993 {published data only}
  • Mathias KD, Lüth I, Haarmann P. Percutaneous transluminal angioplasty of proximal subclavian artery occlusions. Cardiovascular and Interventional Radiology 1993;16:214-8.
Motarjeme 1996 {published data only}
Schillinger 2001 {published data only}
  • Schillinger M, Haumer M, Schillinger S, Ahmadi R, Minar E. Risk stratification for subclavian artery angioplasty: is there an increased rate of restenosis after stent implantation?. Journal of Endovascular Therapy 2001;8(6):550–7.
Sixt 2009 {published data only}
Westerband 2003 {published data only}
  • Westerband A, Rodriguez JA, Ramaiah VG, Diethrich EB. Endovascular therapy in prevention and management of coronary-subclavian steal. Journal of Vascular Surgery 2003;38(4):699-703.

Additional references

  1. Top of page
  2. AbstractRésumé scientifique
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. What's new
  13. Contributions of authors
  14. Declarations of interest
  15. Sources of support
  16. Characteristics of studies
  17. References to studies excluded from this review
  18. Additional references
Bachman 1980
  • Bachman DM, Kim RM. Transluminal dilatation for subclavian steal syndrome. American Journal of Roentgenology 1980;135(5):995-6.
Bucher 1997
  • Bucher HC, Guyatt GH, Griffith LE, Walter SD. The results of direct and indirect treatment comparisons in meta-analysis of randomized controlled trials. Journal of Clinical Epidemiology 1997;50(6):683-91.
Chatterjee 2013
  • Chatterjee S, Nerella N, Chakravarty S, Shani J. Angioplasty alone versus angioplasty and stenting for subclavian artery stenosis - a systematic review and meta-analysis. American Journal of Therapeutics 2013;20(5):520-3.
Deeks 2001
  • Deeks JJ, Altman DG, Bradburn MJ. Statistical methods for examining heterogeneity and combining results from several studies in seta-Analysis. Systematic reviews in health care: Meta-analysis in context. 2nd Edition. London: BMJ Publication Group, 2001.
DerSimonian 1986
Higgins 2003
Higgins 2011
  • Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane-handbook.org.
Lyon 1996
  • Lyon RD, Shonnard KM, McCarter DL, Hammond SL, Ferguson D, Rholl KS. Supra-aortic arterial stenoses: management with Palmaz balloon-expandable intraluminal stents. Journal of Vascular and Interventional Radiology 1996;7(6):825-35.
Palmaz 1987
  • Palmaz JC, Kopp DT, Hayashi H, Schatz RA, Hunter G, Tio FO, et al. Normal and stenotic renal arteries: experimental balloon-expandable intraluminal stenting. Radiology 1987;164(3):705-8.
Rodriguez-Lopez 1999
  • Rodriguez-Lopez JA, Werner A, Martinez R, Torruella LJ, Ray LI, Diethrich EB. Stenting for atherosclerotic occlusive disease of the subclavian artery. Annals of Vascular Surgery 1999;13(3):254-60.
Shadman 2004
  • Shadman R, Criqui MH, Bundens WP, Fronek A, Denenberg JO, Gamst AC, et al. Subclavian artery stenosis: prevalence, risk factors, and association with cardiovascular diseases. Journal of the American College of Cardiology 2004;44(3):618-23.
White 2007