ABSTRACT
Subclavian artery stenoses or occlusions can cause symptoms in both the cerebral and brachial territories. The natural history of most symptomatic lesions is usually more benign than in the carotid circulation. Intracerebral emboli are prevented by reversed flow in the vertebral arteries for the most part, so neurological symptoms are flow-related, generally reversible, and less likely to cause stroke. In fact, deliberate covering of the left subclavian artery orifice is sometimes performed in thoracic aortic stent grafting without either corrective surgery or subsequent disabling symptoms. The subclavian arteries are, in fact, generally good candidates for endoluminal intervention because they are large arteries with relatively high flow. If balloon-expandable stents are to be used, the safest approach involves advancing the sheath through the lesion before the stent, and then pulling the sheath back, exposing the stent just before deployment.
