Endovascular stents in the management of coarctation of the aorta in the adolescent and adult: one year follow up

Abstract

Objectives-To test the hypothesis that endovascular stents used with dilation of coarctation of the aorta (CoA) improve late outcomes. Balloon dilation for CoA has been limited by concerns over the risk for acute dissection, late restenosis, or aneurysm formation. Design-All patients seen with CoA between November 1994 and September 1997 underwent attempted stent implantation. Follow up was obtained for all patients and a subgroup (n = 18) had repeat catheterisation at a mean (SD) of 1.3 (0.5) years to assess residual gradient and stentCoA morphology. Results-Stents were placed in 27 patients (15 male and 12 female patients, mean age 30.1 (13.1) years), of whom seven had prior surgical coarctectomy and one had a prior balloon dilation. Hypertension was present in 26 patients (mean pressure 164 (26)/86 (13) mm Hg), of whom 16 were on antihypertension drugs. CoA gradients were 46 (20) mm Hg (range 18-106 mm Hg) at baseline and 3 (5) mm Hg after the procedure. One patient had a stroke following the procedure; another patient had incomplete dilation and underwent a second procedure. At 1.8 (1) years after the procedure the mean pressure was 130 (14)/74 (11) mm Hg with seven patients on antihypertension treatment. The clinical gradient was 4 (8) mm Hg (range 0-32 mm Hg). At follow up angiography, the mean gradient was 4(6) mm Hg, and two patients had a gradient over 10 mm Hg. Aneurysms formed in three patients at the dilation site; one patient was referred for surgery. Conclusion-In this age group stent management for CoA appears to be an eVective technique and results in sustained reduction in CoA gradients at early term follow up, but aortic aneurysm was detected in 17% of patients who had repeat angiography. (Heart 2001;85:561-566)

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

“…Mean gradient at catheterisation was 71.7 ± 28.6 mm hg and mean gradient post procedure was 3.6 ± 4.4 mmhg. In our literature search, similar encouraging results have been reported in other countries -Harrison et al found that the mean peak pressure gradient of 46 ± 20 mmHg at baseline was reduced to a mean gradient of 4 ± 6 (range 0-26) mmHg at follow-up 1-3 years later (6) . 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) .…”

Caveat Emptor

“…This falls into a mid-range when compared with other studies of coarctation stenting (56%-88%). 5,[8][9][10][11][12][13] As this study demonstrated, complications today are uncommon and meticulous attention to detail will continue to keep rates low. We do not support a standard dose of heparin and default to a weight-based heparin load followed by activated clotting time monitoring, and we do not use the brachial artery for a second arterial access because a randomized angioplasty trial has identified brachial access with the highest rate of complications versus radial with the lowest and femoral arterial next.…”

“…3 Several surgical approaches have evolved during the years, with percutaneous treatment options only becoming available in the 1980s, first with balloon angioplasty and balloon expandable stent implantation in the late 1990s. 4,5 Although clinical acceptance of percutaneous approaches was initially slow, improved techniques, operator experience, and balloon and stent technology have resulted in an enhanced clinical acceptance with improved safety profiles and success rates, although not without controversy. 6 There remains a scarcity, however, of long-term follow-up studies after endovascular repair in regards to the development of aneurysm formation, recurrent obstruction, and general cardiovascular mortality and morbidity.…”

Endovascular Management of Aortic Coarctation in an Adult Patient

“…The study confirmed the hypothesis but went on to mention that approximately one-fifth of the patients who underwent angiography came back with aortic dilatation. 4 …”