Stent treatment for coarctation of the aorta: intermediate term follow up and technical considerations

Abstract

Objective-To report the initial and intermediate term results of stent implantation in children with coarctation of the aorta. Patients and design-17 patients with coarctation of the aorta underwent stent implantation (median age 11 years, range 0.4-15 years); six were treated for isolated coarctation, nine for recurrent coarctation (five after surgical repair and four after balloon dilatation), and two for complex long segment coarctation. Interventions-The procedure was guided by a second catheter placed transseptally in the left ventricle or the aorta proximal to the coarctation site, for angiographic and haemodynamic monitoring during the procedure. Twenty two stents were implanted in 17 patients. One of the patients with long segment coarctation received four stents and the other three. Palmaz 4014 stents were placed in 11 patients, Palmaz 308 in five, and Palmaz 154 in one. Results-Immediately after stent implantation the peak systolic gradient (mean (SD)) fell from 50.0 (24.5) to 2.1 (2.4) mm Hg (p < 0.05). The diameter of the stenotic lesion increased from 5.1 (1.5) mm to 13.9 (2.4) mm (p < 0.05). There were no deaths or procedure related complications. At a median follow up of 33 months, no cases of recoarctation were identified, either clinically (0/17; 0%, 95% confidence interval (CI) 0% to 19%) or angiographically (0/13; 0%, 95% CI 0% to 25%). Conclusions-Stent implantation for the treatment of coarctation of the aorta appears to have very low morbidity and mortality, and reasonable intermediate term results. Long term freedom from recoarctation using this method remains to be determined in comparison with simple balloon dilatation. (Heart 2000;84:65-70)

Endovascular stents for treatment of coarctation of the aorta

“…Stents provide excellent radial support across the coarctated segment preventing restenosis and also provide tamponade against the aortic wall, which is especially the case with the covered stents. This tamponade provides both prevention and treatment for intimal tears, aneurysm formation and localized dissections at the site of coarctation (3,(5)(6)(7)(8). Similar with other reports, our patients had immediate relief of coarctation, with residual gradient decreasing from 37.5 mmHg to 7.2 mmHg.…”

Balloon Angioplasty of Subatretic Coarctation of the Aorta Using Progressive Larger Balloons

“…This technique is used in some patients with subatretic coarctation, in which a two-stage approach is advocated. In these cases the balloon dilatation is followed by stent implantation after a few months [7,8] or in the same procedure [9,10]. Our patient had a good result.…”

Interventional treatment of haemodynamically interrupted aortic arch with stent implantation in a 9-year-old patient – a

“…In these situations interventional treatment with stent implantation is a feasible and effective method [9]. In the case of primary aortic isthmus stenosis most authors suggest the use of stents without balloon angioplasty to limit the risk of aortic wall injury [10]. In our case pre-dilation of the critically stenosed aortic isthmus was necessary for safe and atraumatic to the aortic wall introduction of the long intravascular sheath used for stent implantation through the site of stenosis.…”