Baseline characteristics of all studied patients are given in table 1 . Their mean age of 56 (+7.8%). 93 patients (93%) were males & 7 patients (7%) were females.
Among patients studied: 43 patients (43%) were smokers, 67 patients (67%) were hypertensives, 52 patients (52%) were diabetic and 52 patients (52%) were dyslipidemic.
The patients had a variety of clinical presentations as follows; 46 patients (46%) presented with unstable angina, 15 patients (15%) presented with non ST elevation myocardial infarction (NSTEMI), 25 patients (25%) presented with ST elevation myocardial infarction (STEMI) and 14 patients (14%) presented with heart failure
Among patients studied , 5 patients were identified to had subclavian arterial disease. Their characteristic features & comparison to patients without subclavian arterial disease are shown in table 2.
From table 2 ; The patients had subclavian arterial disease represent 5% of studied group. Their mean age of
51 (+6.2). All of them were males & had no intracranial vascular stenosis. They were found to had statistically higher incidence of dyslipidemia , smoking , history of recent or old Stroke/ transient ischemic attack (TIA) , extra cranial moderate or severe carotid stenosis & multi-vessel or left main coronary artery disease.
In patients having subclavian stenosis or total occlusion we observed a variety of Doppler waveforms in epsilateral vertebral artery that include:
1 - Retrograde flow: the whole Doppler wave form is below the baseline.
2 - Antegrade Doppler flow with a:
A - Transient sharp decline in blood flow velocity at mid systole, rounding of a subsequent second systolic peak, and restoration of forward flow in diastole.
B - Nadir of mid systolic cleft in blood flow velocity is at or below baseline, but with a rapid recovery of forward flow before diastole.
3- Retrograde & antegrade Doppler flow with a : nadir of mid systolic cleft falls well below baseline signifying greater reversal of flow during systole. Forward flow is restored in diastole.
Table 1. Clinical features of patients enrolled in the study
Clinical features
|
Number of patients
|
Age (year)
|
56 (+7.8%)
|
Male gender
|
93 (93%)
|
Smoking
|
43 (43%)
|
Hypertension
|
67 (67%)
|
Diabetes Mellitus
|
52 (52%)
|
Dyslipidemia
|
52 (52%)
|
Unstable angina
|
46 (46%)
|
NSTEMI
|
15 (15%)
|
STEMI
|
25 (25%)
|
Heart failure
|
14 (14%)
|
Table 2. Clinical, echocardiographic and angiographic features in patients with Subclavian stenosis compared to patients without Subclavian stenosis
Clinical featuers
|
Subgroup A
|
Subgroup B
|
P value
|
Number of patients
|
5
|
95
|
|
Age (year)
|
51 (+6.2)
|
59 (+3.4)
|
NS
|
Male gender
|
5 (100%)
|
87 pts (91.6%)
|
NS
|
Smoking
|
4 pts (80%)
|
39 pts (41%)
|
P< 0.05
|
Hypertension
|
3 pts (60%)
|
64 pts (67.4%)
|
NS
|
Diabetes Mellitus
|
3 pts (60%)
|
49 pts (51.6 %)
|
NS
|
Dyslipidemia
|
4 pts (80%)
|
48 pts (50.5%)
|
P< 0.05
|
Unstable angina
|
2(40%)
|
44(51.6%)
|
NS
|
NSTEMI
|
1 (20%)
|
14 (14.7%)
|
NS
|
STEMI
|
1 (20%)
|
24 (25.3%)
|
NS
|
LV systolic dysfunction
|
1 (20%)
|
13 (13.7%)
|
NS
|
Recent or old Stroke/TIA
|
4 (80%)
|
38 (40%)
|
P< 0.05
|
Extra cranial carotid stenosis (moderate or severe)
|
3 (60%)
|
13 (13.7%)
|
P< 0.05
|
Intracranial vascular stenosis
|
-
|
6 (6.3%)
|
P< 0.05
|
Multi-vessel or left main coronary disease
|
3 (60%)
|
30 (31.6%)
|
P< 0.05
|