Stenting complex aortic arch obstructions

Abstract

Stenting of complex aortic arch lesions can be performed safely and effectively with excellent, immediate, and midterm results. Patients with a weight below 10 kg or after Hybrid stage I palliation are at increased risk of adverse events. Stents can be placed across major arch vessels without compromising distal perfusion in otherwise normal vasculature.

Transcatheter Therapy for Coarctation of Aorta: Analysis of 150 Cases

“…20 This was soon followed by studies demonstrating its ability to be re-expanded in a swine model aorta, with eventual use of the stent to treat native and recurrent coarctation of the aorta. 21,22 Since the mid-1990s, with its first use in an infant and followed by a small series in adults, 23,24 this therapy for COA has gained acceptance as a primary option for treating native and recurrent COA in adolescents and adults. 24 To provide a stable track to advance and deploy the balloon/stent segment, an exchange-length Amplatzer extra-or super-stiff (St. Jude Medical, St. Paul, MN) wire is positioned in the ascending aorta or right subclavian artery.…”

“…21,22 Since the mid-1990s, with its first use in an infant and followed by a small series in adults, 23,24 this therapy for COA has gained acceptance as a primary option for treating native and recurrent COA in adolescents and adults. 24 To provide a stable track to advance and deploy the balloon/stent segment, an exchange-length Amplatzer extra-or super-stiff (St. Jude Medical, St. Paul, MN) wire is positioned in the ascending aorta or right subclavian artery. The stent is hand-crimped on the balloon catheter, with the extremely low profile balloons requiring inflation to 0.6 atmosphere to allow for adequate stent/balloon traction, thereby preventing stent slippage during advancement through the long sheath.…”

Intravascular Stent Therapy for Coarctation of the Aorta

“…the ev3 Mega and Max ld stent, with their open cell design, minimal foreshortening, and considerable flexibility, are the preferred stent for treatment of transverse aortic arch obstruction when the overlapping of head and neck vessels is likely to be required. 2,23 Indication and Catheterization Technique the initial presentation of symptoms differs between infants and children/adults ("older patient") presenting with native Coa. the primary indication for intervening in the older patient is resting hypertension, an "accurate" upper-to lower-extremity systolic gradient of > 20 mm hg, and/or the presence of symptoms (claudication/headaches).…”

“…alternatively placing a surgical jump graft from the carotid to the lsa prior to placement of a covered stent may be preferable to extensive arch surgery. 23 in addition, prior deal with aortic wall emergencies, and anticipatory preparedness prior to is in the catheterization lab is warranted. the true incidence of aortic aneurysm remains elusive, with studies reporting in the range of 5% to 9%.…”

“…[19][20][21] since the mid-1990s, with its first use in an infant and followed by a small series in adults, 19,21,22 is therapy for Coa has gained acceptance as a primary option for treating native and recurrent Coa in adolescents and adults. 10,11,15,23,24 significant technological advances have been made in recent years to achieve the desirable characteristics of an ideal stent, including higher flexibility, lower profile, the ability to further dilate to adult size with somatic growth, minimal foreshortening with maximal expansion, high radial strength, non-sharp edges, and open cell strut configuration when a brachiocephalic vessel requires overlapping. 2,10,23 figure 1 shows the most commonly used stents for treatment of Coa, and table 1 and figure 2 summarize the characteristics and radial strengths of stents …”