Percutaneous Stent Placement to Treat Coarctation of Aorta Due to Atresia in Adult Patients

González, Luís Fernández; Román, Koldobika García San; Blanco-Mata, Roberto; Meabe, Josune Arriola; Burgo, Juan Carlos Astorga; Villa, Juan Alcibar

doi:10.1016/j.rec.2016.05.019

Cited by 4 publications

(5 citation statements)

References 6 publications

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“…However, large aneurysms of collateral arteries are more prevalent in elderly patients with CoA ( 43 ). Several case reports demonstrate that, for instance, spinal and intercostal artery aneurysms are at risk for rupture, potentially with fatal outcomes ( 44 ). However, current guidelines fail to address the management of these aneurysms ( 45 – 47 ).…”

Section: Discussionmentioning

confidence: 99%

A percutaneous treatment strategy of an adult patient with a bicuspid aortic valve, coarctation of the aorta, and an exceptionally large aneurysm of a collateral artery: Case report and literature overview

Verheijen

Stöger

Kley

et al. 2022

Front. Cardiovasc. Med.

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Coarctation of the aorta (CoA) is a congenital heart defect that is associated with a bicuspid aortic valve (BAV), ascending aorta dilatation, intracerebral aneurysms, and premature atherosclerotic disease. The first presentation during late adulthood is rare and is frequently driven by late sequelae. Hypertrophic collateral arteries can develop aneurysms which are at risk for spontaneous rupture, however, treatment recommendations for these aneurysms are scarce. Here, we describe the clinical course and percutaneous treatment strategy of a patient with a late diagnosis of a pin-point CoA, a BAV with moderate regurgitation, and an exceptionally large aneurysm of a collateral artery. A 59-year-old woman was diagnosed with Streptococcus bovis endocarditis of a BAV with moderate aortic valve regurgitation and small vegetation (<5 mm) on the non-coronary cusp. Work-up revealed hypertension and adenocarcinoma in situ of the ascending colon, considered the bacteremia porte d’entrée, for which a curative hemicolectomy was performed. Echocardiography showed a narrowing of the aorta distal from the origin of the left subclavian artery with the antegrade diastolic flow with a pathognomonic “sawtooth” pattern and an estimated pressure gradient of >70 mmHg. Computed tomography angiography (CTA) showed a network of well-developed collateral arteries and a levoatriocardinal vein. One of the collateral arteries arising from the left subclavian artery revealed an exceptionally large aneurysmatic dilation (29 × 24 × 24 mm). The invasive assessment confirmed a hemodynamically significant CoA. Treatment involved balloon dilatation and placement of a covered stent at the site of the pin-point CoA and a percutaneous coronary intervention (PCI) of the stenosis in the left anterior descending artery. No residual gradient over the CoA was observed. Antihypertensive drugs could be discontinued, and CTA performed 4 months later showed regression and thrombosis of the numerous collaterals and, importantly, thrombosis of the large aneurysm. This case illustrates the late diagnosis of CoA with associated congenital heart defects and late sequelae including hypertension, BAV endocarditis, coronary artery disease, and aneurysm formation of the extensive collateral network. The patient underwent pharmacological and percutaneous treatment, ultimately resulting in the alleviation of the CoA, normalization of the blood pressure, reduction of collateral flow, and thrombosis of the large aneurysm of the collateral artery.

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Section: Discussionmentioning

confidence: 99%

A percutaneous treatment strategy of an adult patient with a bicuspid aortic valve, coarctation of the aorta, and an exceptionally large aneurysm of a collateral artery: Case report and literature overview

Verheijen

Stöger

Kley

et al. 2022

Front. Cardiovasc. Med.

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show abstract

“…One case study has demonstrated that in their experience, totally occluded coarctation of the aorta represents 4% of the total number of percutaneous interventions in coarctation of the aorta and 12% of cases involving stent implantation. 13…”

Section: Discussionmentioning

confidence: 99%

“…This has been shown to prevent stent slippage and reduce the incidence of complications. 13 The predominant disadvantage of covered stent grafts is potential occlusion of side branches if there is insufficient proximal and distal “landing-zones.” 14…”

Section: Discussionmentioning

confidence: 99%

A Case Series Describing Percutaneous Management of Aortic Isthmic Atresia

Menon

Walsh

2020

Vasc Endovascular Surg

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Aortic isthmic atresia is a severe form of aortic coarctation where there is loss of luminal communication at the aortic isthmus. The primary approach for correcting aortic isthmic atresia has been surgical repair of the coarctation. A small number of case series have shown that percutaneous correction of aortic isthmic atresia is possible. We describe 3 cases of aortic isthmic atresia that was successfully treated using a percutaneous approach. Our cases ranged in age between 42 and 51 years, and they all had hypertension. In our case series, 2 patients were successfully treated with radiofrequency perforation and 1 patient had anterograde recanalization performed using a stiff wire. Our patients have been followed up for between 2 and 4 years post-procedure, and they continue to do well. The success of percutaneous management in this case series adds to the small but increasing amount of data available in support of endovascular management of aortic isthmic atresia in adult patients.

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“…wires can sometimes allow passage but (as in our case) this is not always possible. 2 An alternate option for crossing such narrowing's uses a Brockenbrough needle. 3 However, this has disadvantages with the potential for unanticipated aortic wall damage due to the angulated needle which cannot always be comfortably controlled, particularly as kit is manipulated over it.…”

mentioning

confidence: 99%

“…4 Previous groups have also described the use of dedicated radiofrequency wires to cross these lesions. 2,5 However, these technologies are not available in all catheter laboratories and require a specific RF wire which is slightly more bulky that a standard 0.014-inch wire. Additionally, the RF generator is designed to provide bursts of up to 25 W requiring longer activation times 5 with the potential for inadvertent deflection and damage.…”

mentioning

confidence: 99%

Electrification of a Guidewire to Assist in Crossing an Aortic Coarctation (The BEACON Technique)

Broyd

Smith

Matson

et al. 2020

The American Journal of Cardiology

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Percutaneous Stent Placement to Treat Coarctation of Aorta Due to Atresia in Adult Patients

Cited by 4 publications

References 6 publications

A percutaneous treatment strategy of an adult patient with a bicuspid aortic valve, coarctation of the aorta, and an exceptionally large aneurysm of a collateral artery: Case report and literature overview

A percutaneous treatment strategy of an adult patient with a bicuspid aortic valve, coarctation of the aorta, and an exceptionally large aneurysm of a collateral artery: Case report and literature overview

A Case Series Describing Percutaneous Management of Aortic Isthmic Atresia

Electrification of a Guidewire to Assist in Crossing an Aortic Coarctation (The BEACON Technique)

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