Angioplasty Alone Versus Angioplasty and Stenting for Subclavian Artery Stenosis—A Systematic Review and Meta-analysis Saurav Chatterjee, MD,* ,1 Nishant Nerella, MD, 1 Saneka Chakravarty, MD, 2 and Jacob Shani, MD, FACP, FACC, FSCAI 1 Subclavian artery stenosis has long been treated with great success with bypass surgery. Percutane- ous intervention, often used in combination with stent placement, has come into vogue for the past few years as a safe and effective therapeutic modality. This study aimed to compare angioplasty alone with angioplasty followed by stent placement by combining available data. The objective of this study was to perform a review of the available literature to compare the efficacy of percutaneous transluminal angioplasty (PTA) alone with PTA followed by stent placement for proximal subclavian artery stenosis. Successful recanalization was defined as patency at the end of 1 year, and reocclu- sions and restenoses were noted as events for the purpose of pooling the data. The authors searched the Specialized Register and the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, PubMed, EMBASE, and CINAHL databases for relevant trials/studies comparing PTA and PTA with stenting. Review authors independently assessed the methodological quality of studies (focusing on the adequacy of the randomization process, allocation concealment, blinding, completeness of follow-up, and intention-to-treat analysis) and selected studies for inclusion. All retrospective observational studies were also included in the analysis in the absence of double- blinded randomized trials for increasing sample size. All analyses were done using RevMan 5.0. Odds ratio was calculated using Mantel–Haenszel test with a fixed effect model. All included studies were assessed by all authors for potential sources of bias. Eight studies were included in the analysis having 544 participants. Stenting after PTA was significantly superior to angioplasty alone for treatment of subclavian artery stenosis and maintenance of patency at 1 year, as indicated by absence of events (P 5 0.004; 95% confidence interval, odds ratio 2.37 [1.32–4.26]) without significant complication rates for either procedure. There is evidence in favor of stent placement after angio- plasty for successful recanalization of stenosed subclavian arteries and long-term maintenance of patency without significant increase in risk for major complications in subjects. Keywords: subclavian artery stenosis, angioplasty, stenting INTRODUCTION Subclavian stenosis/occlusion is a marker for athero- sclerotic disease (eg, carotid, coronary, lower extremity arteries) and future adverse cardiovascular events. The approach to therapy of subclavian steal associated with symptoms varies with the clinical setting. In many patients, symptoms improve over time without treatment. Interventional treatment is not usually war- ranted in patients with asymptomatic subclavian 1 Department of Medicine, Maimonides Medical Center, Brooklyn, NY; and 2 Department of Medicine, Division of Cardiology, University of Connecticut School of Medicine, Farmington, CT. The authors have no conflicts of interest to declare. *Address for correspondence: Department of Medicine, Maimo- nides Medical Center, 4802 10th Avenue, Brooklyn, NY 11219. E-mail: saurav.sphs@gmail.com American Journal of Therapeutics 20, 520–523 (2013) 1075–2765 Ó 2013 Lippincott Williams & Wilkins www.americantherapeutics.com