Predictive factors for residual hypertension following aortic coarctation stenting

Abstract

Native coarctation of the aorta (CoA) and recoarctation (reCoA) after initial surgical repair are frequently associated with hypertension (HT). Most CoA cases are amenable to transcatheter balloon angioplasty with stent implantation; however, the impact of stenting on arterial blood pressure (BP) is variable. We carried out a retrospective study to identify the predictive factors for residual HT despite optimal endovascular treatment. Patients who had undergone stent implantation for native CoA or reCoA with a pressure gradient of >20 mm Hg between the upper and lower limbs, between 2007 and 2015, were included. The geometry and level of hypoplasia of the aortic arch were determined by non‐invasive imaging, and BP measurements were performed pre‐ and post‐procedure. Thirty consecutive patients (median age: 18.5 years; 76.7% male) were included. Twenty‐three patients had HT before the procedure and 14 (46.7%) had post‐procedural HT despite optimal endovascular treatment. Residual HT post‐stenting was associated with longer stent length and gothic arch geometry. Age and body mass index (BMI) were also associated with residual HT. The pathologic association of abnormal arch geometry and aortic stent placement may lead to a loss of aortic compliance that is further increased by high BMI and older age. Determination of a patient's aortic arch anatomy and clinical profile can assist in defining those at high risk of residual HT despite optimized isthmic stent implantation.

Transverse arch stenting and its effect on systemic hypertension

“…It does not make patients completely normotensive because there are other reasons for the persistence of systemic hypertension in these patients, such as underlying renal adaptation, endothelial dysfunction, neurohormonal imbalances, or coexisting vascular abnormalities and baroreceptor disturbances. [13][14][15][16] No clear consensus exists in the literature on the choice of antihypertensive therapy in patients with coarctation. Angiotensin-converting enzyme inhibitors (ACEi), beta-blockers, or calcium channel blockers can be given as first-line therapy.…”

Is surgery necessary for adults with isolated interrupted aortic arch?: Case series with literature review

“…Considering that the postoperative management of IAA is similar to that of coarctation of the aorta, we reviewed the relevant data of coarctation of the aorta and found that 68% of patients still have hypertension after surgery. This lack of blood pressure improvement may be related to abnormal geometry of the aortic arch, hypoplasia of the arch, changes in arterial function, hyperactivation of the renin angiotensin system, and attenuation of baroreflexes 48 …”

Acute and medium term results of balloon expandable stent placement in the transverse arch—a multicenter pediatric interventional cardiology early career society study

“…Another concern has been for incomplete resolution of stenosis given angled aortic arches and nonconformity of stents in that location, especially in the presence of gothic arches 26 . There might be multiple areas of stenosis in patients with gothic arches that can add to the decision‐making challenges.…”

“…Other Another concern has been for incomplete resolution of stenosis given angled aortic arches and nonconformity of stents in that location, especially in the presence of gothic arches. 26 There might be multiple areas of stenosis in patients with gothic arches that can add to the decision-making challenges. The arch angulation and wall stress in the region of the TAO may contribute to late stent fracture, aortic wall dissection or rupture, and aneurysm formation.…”