Endovascular stenting for aortic (re)coarctation in adults

Abstract

Objectives. Stenting for native and recurrent coarctation (COA) in adults has become an important therapeutic strategy. In this prospective observational study we evaluated the intermediate-term outcome of stent implantation for either native or recurrent (re)COA in adults.Methods. All adults who underwent stent implantation in our institution between January 2003 and December 2008 were included. Diagnosis of (re)COA was based upon a combination of clinical signs, noninvasive imaging or invasive gradient measurements. NuMED stents were implanted under general anaesthesia.Results. Twenty-four patients (50% male) underwent stent implantation for native (n=6) or reCOA (n=18) at a median age of 36 (18 to 60) years. There was significant improvement in pre- versus post-stent invasive systolic gradient (19 vs. 0 mmHg, p<0.001) and COA diameter (10 vs. 16 mm, p<0.001). Acute complications (12.5%) included death due to aortic rupture despite immediate successful coverage with a covered stent (n=1) and groin haematoma (n=2). During a median follow-up period of 33 (8 to 77) months (n=22), late complications occurred in three patients (13.6%): stent migration to the ascending aorta (n=1), pseudoaneurysm at the site of the initial stent (n=1), and occluded external iliac artery (n=1). Stent implantation did not reduce the need for antihypertensive medication or blood pressure at last follow-up. Conclusion. COA stenting results in a significant gradient decrease and increase in vessel diameter. However, serious complications do occur and hypertension remains in the majority of patients. (Neth Heart J 2010;18:430-6.).

Coarctation of the aorta: nonsurgical treatment using stent implantation

“…In Hamdan et al's study, (5) the peak systolic pressure gradient measured at catheterisation decreased from 32 ± 12 mmHg to 4 ± 11 mmHg, while the echocardiographic Doppler gradient decreased from 51 ± 26 mmHg to 13 ± 11 mmHg at follow-up. Other similar reports showed significant improvement in the pressure gradients (19)(20)(21) and CoA diameters (14,19,22) before and after stent implantation.…”

“…Another well-recognised complication is the persistence of hypertension in patients with CoA. (19,20,25) Serious complications have also been reported with stent implantation. (18) The complications associated with CoA stenting include damage to the femoral artery and thrombus formation due to the large sheaths and balloon catheters required.…”

Editor's Choice – Management of Descending Thoracic Aorta Diseases

“…268 Provided anatomical suitability, an endovascular-first approach may be beneficial for the treatment of re-coarctation. 269 …”

Procedural Outcome and Short Term Follow Up of Patients Undergoing Endovascular Stenting for Coarctation of Aorta: A Single Centre Experience

“…In Hamdan et al's study the peak systolic pressure gradient measured at catheterisation decreased from 32 ± 12 mmHg to 4 ± 11 mmHg, while the echocardiographic Doppler gradient decreased from 51 ± 26 mmHg to 13 ± 11 mmHg at follow-up , (7) . Other similar reports showed significant improvement in the pressure gradients and CoA diameters before and after stent implantation (11,12,13,15,18) . In a recent multi institutional study, Forbes and colleagues presented results of 217 patients who had stent implantation to treat AC.…”

“…Another patient in our study developed right common femoral artery thrombosis .Another wellrecognised complication is the persistence of hypertension in patients with Coarctation even after successful correction (12,15,16) . On follow up 36.4% of our patients required continuation of antihypertensive therapy even after stenting.…”