Endovascular Correction of Ostial Stenosis of a Tortuous Right Subclavian Artery in a Patient with Crisis Course of Arterial Hypertension: A Clinical Case

Abstract

Background: Subclavian artery stenosis is a rare but clinically significant cause of vertebrobasilar insufficiency and upper extremity
ischaemia. The presence of marked vessel tortuosity poses substantial technical challenges for endovascular revascularisation.
Case summary: A 62-year-old male presented with progressive numbness and paraesthesia of the right upper extremity, right-sided
cephalic bruit, and labile arterial hypertension persisting despite optimal medical therapy. Instrumental examination revealed 95%
ostial stenosis of the right subclavian artery with severe tortuosity and subclavian-vertebral steal syndrome. Coronary angiography
demonstrated haemodynamically insignificant coronary artery disease. Successful endovascular treatment was performed. After
predilatation, a balloon-expandable Express LD Vascular stent (9 × 25 mm) was implanted. Control angiography showed good stent
apposition, residual stenosis <10%, and restoration of antegrade flow in the right vertebral artery. Immediate symptom relief was
achieved. The patient was discharged on the third postoperative day on dual antiplatelet therapy. At 1-month follow-up, the patient
remained asymptomatic with no recurrence of neurological symptoms.
Discussion: This case underscores the importance of access site selection in complex subclavian artery anatomy. Femoral access provided
an optimal trajectory for device delivery despite severe vessel tortuosity. A balloon-expandable stent was chosen to ensure precise
ostial implantation and high radial force. The chosen strategy is consistent with current ESC guidelines, which favour endovascular
therapy in patients at high surgical risk.