Intravascular Stent Therapy for Coarctation of the Aorta

Abstract

Intravascular stent therapy is considered a primary therapeutic option for most adults and adolescents with coarctation of the aorta. This review highlights the indications, technical considerations, procedural aspects, and limited long-term outcome data when using this intervention. Stent technology has continued to evolve with potential for further modifications since its inception in the early 1990s. The best therapeutic approach, e.g., stenting versus surgery, in the treatment of native coarctation continues to be debated due to the paucity of long-term clinical and imaging data in both groups.

Single stage repair for aortic root aneurysm in a patient with coexisting coarctation incorporating the Cabrol technique: a case report

“…However, there is insufficient long-term data available in comparing these interventions with surgical repair. Although these approaches are often associated with lower morbidity compared to surgery, there is an increased rate of re-stenosis 11% versus 2% [6, 7] hence a higher need for reintervention. Reintervention may also be required due to stent fracture, migration and possible aneurysm formation.…”

Outcomes of thoracic endovascular aortic repair in adult coarctation patients

“…In general, if patients presented with complications after open repair of an AC, such as pseudoaneurysm, aneurysm, or dissection, a low threshold for recommending intervention existed because of the reported poor natural history of these lesions. 8,14,15 Ankle-brachial index with bilateral brachial pressure assessment was obtained selectively and was predominantly used for patients presenting with claudication. All patients underwent preoperative transthoracic echocardiography irrespective of the surgical indication.…”

“…6,7 Because of early and late morbidity of open reconstruction, bare-metal stents (BMSs) have largely supplanted open repair in many older children and adults. 8 Unfortunately, the BMS is also associated with long-term complications, such as aneurysm, dissection, and recurrent coarctation from poor stent expansion in 5% to 25% of cases. 1,[9][10][11][12][13] An alternative solution is thoracic endovascular aortic repair (TEVAR) because several reports highlight its use in treating complications after open AC repair.…”

“…Moreover, significant concerns exist about the efficacy of this strategy as stent grafts may not provide sufficient aortic expansion to treat the sequelae of coarctation. 8,17 The purpose of this analysis was to describe our experience with TEVAR in adults presenting with late sequelae of untreated coarctation or complications of the index repair.…”

Cardiac Catheterization for Congenital Heart Disease

“…Typically, the diameter of the stent should not exceed the abdominal aorta diameter. Additionally, the ratio of the stent diameter to the narrowest coarctation segment should be less than 3.5 [26]. Once the stent is chosen, it is loaded over a balloon-in-balloon catheter.…”