Supra aortic occlusive disease is atherosclerosis of supra aortic arterial branches,
and is characterized by stenosis or occlusion of the blood vessel lumen. Stenosis is caused by the creation of an atherosclerotic plaque in the intima of the blood vessel and usually covers carotid bifurcation and / or internal carotid artery (fig. 2),
brachiocephalic trunk,
and left subclavian artery (1).
Carotid disease is a major cause of cerebrovascular disease,
which are the third most common cause of death (2,3).
Carotid artery stenosis,
subclavian artery stenois,
and brachiocephalic stenosis can be asymptomatic or symptomatic.
According to the duration and reversibility of symptoms,
carotid artery stenosis may present as transient ischemic attack (TIA),
reversible ischemic neurological deficit (RIND) or ischemic stroke.
In the case of brachiocephalic trunk and / or the subclavian artery occlusion or subocclusion,
especially in multisegmet lesions of supra aortic branches,
ischemia may occur in the upper limbs.
Ischemic symptoms may occur as acute and chronic,
in all degrees of difficulty,
from occasional and mild coldness,
paresthesia and pallor,
to severe rest pain and gangrene of the toes (4,5).
Diagnosis of supra aortalne occlusive disease is made by mandatory clinical exam,
multi-slice computed tomography (MSCTA) and digital subtraction angiography (DSA)-as the gold standard.
Treatment of supra aortic occlusive diseases may be nonoperative (conservative) and operativel.
- Nonoperative treatment includes treatment of risk factors that may lead to a disease of the arteries,
and medicament antiplatelet therapy.
- Surgical treatment may be:
• Open,
which means endarterectomy and bypass reconstruction (primary) and
• Endovascular,
which includes percutaneous transluminal angioplasty (PTA) and/or stent placement (primary or secundary-restenosis after open endarerectomy).
Our purpose was to analyze the results of endovascular treatment in patients with supraaortic in-stent stenosis,
after primary or secundary endovasculary treated leasions.