Bioabsorbable metal stents for percutaneous treatment of critical recoarctation of the aorta in a newborn

Schranz, Dietmar; Zartner, Peter; Michel‐Behnke, Ina; Akintürk, Hakan

doi:10.1002/ccd.20756

Cited by 176 publications

(95 citation statements)

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“…However, this concept should be tested in appropriate animal models followed by clinical trials to test the feasibility, safely and efficacy. Successful use of a bioabsorbable metal stent in a neonate with for critical recoarctation [36] is encouraging. However, as stated above, orderly clinical trials in large groups of young patients are needed.…”

Section: Biodegradable Stentsmentioning

confidence: 99%

“…Characteristics of ideal biodegradable stents would be: 1) offer sufficient radial strength to prevent vessel recoil, 2) do not induce inflammatory of thrombotic response, 3) reabsorbed within weeks to months and 4) breakdown products are not toxic. Several types of biodegradable stents have been used in animal models and adult subjects, but there is limited use in children [36].…”

Section: Compositionmentioning

confidence: 99%

“…Biodegradable stents [32][33][34][35][36]200,201] may offer a solution. These stents, composed of polyesters, polycarbonates, bacterial-derived polymers, or corrodible metals, initially keep the coarcted aortic segment open and dissolve over a period of months to years.…”

Section: Biodegradable Stentsmentioning

confidence: 99%

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Transcatheter Stent Therapy in Children: An Update

Sahu

Rao²

2012

Pediat Therapeut

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To address elastic recoil of vessel wall and intimal dissection that can follow balloon angioplasty, stents have been designed and these appear to produce more effective relief of obstruction. Of the two types of stents, namely, balloon expandable and self expandable, balloon expandable stents are most commonly used in children. The usefulness of stents in the management of vascular obstructive lesions not amenable to balloon angioplasty is well established and has been successfully used to treat branch pulmonary artery stenosis, coarctation of the aorta, stenotic right ventricular outflow tract conduits, obstructive lesions of the systemic and pulmonary veins and others. The techniques of implantation, indications, immediate and follow-up results and complications were reviewed. The stents have also been effectively used in keeping open naturally occurring or artificially created inter-circulatory connections and as adjuncts in hybrid procedures, but these have not been discussed in this review. Future directions include investigative work on biodegradable stents and growth stents to address issues related to increase in vessel size in infants and children, use of drug eluding stents to prevent neo-intimal proliferation to avoid pulmonary vein restenosis and refinement of stent technology in hybrid procedures such as neonatal palliation of hypoplastic left heart syndrome and transcatheter completion of Fontan procedure. The feasibility, safety and effectiveness stents in the pediatric population are demonstrated, although scrutiny of results of larger experience with longer follow-up is important.

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Section: Biodegradable Stentsmentioning

confidence: 99%

Section: Compositionmentioning

confidence: 99%

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Transcatheter Stent Therapy in Children: An Update

Sahu

Rao²

2012

Pediat Therapeut

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“…From 2005 to 2007 AMS1 was tested in humans treating lower limb arteries in adults (36)(37)(38) as well as aorta and pulmonary arteries in pediatric patients (39)(40)(41).…”

Section: Resorption Processmentioning

confidence: 99%

Magmaris: a new generation metallic sirolimus-eluting fully bioresorbable scaffold: present status and future perspectives

Rapetto¹,

Leoncini²

2017

J. Thorac. Dis.

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Drug-eluting stents (DES) have reached a high safety and efficacy profile, becoming the best option for percutaneous coronary interventions (PCI) based revascularization. However, despite their optimal performance, a few concerns remain regarding their use, mainly due to permanent caging of the vessels and its consequences, first of all late stent thrombosis (ST). Bioresorbable scaffolds (BRS) aim to overcome these issues. The results achieved in randomized controlled trials (RCT) by the first generation of poly-L-lactic acid (PLLA) based scaffolds were promising at 1 year, but the first long term reports (albeit flawed by nonoptimal implantation technique) have been disappointing, showing, for instance, an increased risk of ST and target vessel myocardial infarction (TV-MI). In such a scenario the advent of a newer generation magnesium (Mg) based BRS is welcome, mainly because of its innovative mechanical and chemical features coupled with well proven biocompatibility. Despite being in its infancy, this technology seems to promise a great potential.In our article, we review the Magmaris (Biotronik AG, Bülach, Switzerland) Mg BRS development from animal models to human use, underscore its best qualities and weaknesses, and provide hints of its possible future perspectives.

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“…There is either so severe aortic arch narrowing that is almost indistinguishable from interrupted aortic arch and arch hypoplasia, or on the other end of the spectrum the coarctation is discrete with a localized shelflike lesion within the aortic arch lumen often with tapering of the arch as it courses towards the obstruction [2]. There is more controversy about the optimal management of this vascular anomaly whether to balloon dilatation or stenting the native coarctation or operate upon, which surgical technique to select and the ideal age at intervention and the role of balloons and the different types of stents and the bioabsorbable stents for native and recurrent Coarctation [3]. Despite the initial enthusiasm created by the effectiveness of balloon angioplasty in the treatment of aortic coarctation [4,5], the use of this technique became declined because the reported incidence of early recoarctation [6,7] and in particular, the aneurysm formation in the site of angioplasty [8].…”

Section: Introductionmentioning

confidence: 99%

Short-Term Outcome of Balloon Angioplasty of Discrete Coarctation of Aorta

2017

JCCR

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Introduction: Balloon angioplasty has been proposed as an alternative way to surgery in primary treatment of aortic coarctation (Co A) for both children and infants.Objective: The purpose of this study is to assess the immediate and intermediate term effectiveness and safety of balloon angioplasty in infants and children with native discrete membranous Co A. Patients and methods:Forty consecutive patients with native discrete coarctation of the aorta were treated with balloon angioplasty. They were 8 infants and 32 children; with ages ranged from 2 months to 10 years and all weighted below 35 Kg. All patients were clinically evaluated immediately after and at 6 to 12 months and 18 to 24 months after the procedure. Follow up data were collected and Doppler echocardiography was done before intervention to confirm diagnosis and to plan management and post interventional to follow-up patients and estimate the outcome and complications.Results: Immediate successful relief of native Co A was obtained in 92.5% of the population study, while 7.5% recorded immediate suboptimal results with pressure gradient above 20mmHG. The peak systolic gradient across the coarcted segment was reduced significantly with 82.5% immediately after balloon angioplasty, 75% and 73.2% at the end of first and second follow up period respectively. Pressure gradient decreased significantly from 57±15.7 mmHg before balloon angioplasty to 14.23±11.30mmHg 9 to 12 months after, but it was increased slightly to reach 15.15±11.80 mmHg at the end of the second year. The systolic ascending aortic pressure decreased significantly (19%) and the systolic descending aortic pressure increased significantly (11.4%) at the end of the study. Recoarctation occurred in17.5% at the end of the 1st year and balloon angioplasty was repeated for all patients successfully. At the end of the 2nd year restenosis was evidenced in 10% of the whole study population. Aneurysm formation at the site of coarcted segment occurred in (5%). Conclusion:Balloon angioplasty is an effective and safe alternative to surgery for treatment of Co A in infants older than 2 months and children10 years of age or younger.

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Bioabsorbable metal stents for percutaneous treatment of critical recoarctation of the aorta in a newborn

Cited by 176 publications

References 4 publications

Transcatheter Stent Therapy in Children: An Update

Transcatheter Stent Therapy in Children: An Update

Magmaris: a new generation metallic sirolimus-eluting fully bioresorbable scaffold: present status and future perspectives

Short-Term Outcome of Balloon Angioplasty of Discrete Coarctation of Aorta

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