Treatment of symptomatic coral reef aorta by a nitinol self-expanding stent

Abstract

Coral reef aorta (CRA) is a rare condition, characterised by rock-hard calcification of the juxta-renal and supra-renal aorta with luminal encroachment causing significant stenosis of the aorta and its branches. It usually presents as resistant hypertension, renal dysfunction, mesenteric ischaemia, limb claudication or embolic manifestations. Although surgical thrombo-endarterectomy along with bypass graft to the affected visceral arteries remains the cornerstone of treatment, it is associated with considerable mortality and morbidity, especially in patients with pre-existing comorbidities. Here we report an elderly female of resistant hypertension, who had successful endovascular aortic stenting using a non-graft self-expanding stent. Her blood pressure dramatically improved following endovascular management. In comparison to the conventional surgical approach, endovascular stenting can be an alternative, less invasive approach in selected CRA patients.

Challenging Endovascular Treatment of Coral Reef Aorta and a Literature Review

“…Almost 40 years later, the pathophysiological causative factor remains uncertain, although the most likely hypothesis is the secondary calcification of a thrombus and the implication of inhibitions of insufficient calcification such as serum fetuin-A and uncarboxylated matrix Gla protein. 4,5 CRA affects between 0.6 and 1.8% of the population with a predominance of women over men in a ratio of 1.6:1. It seems to be associated with comorbid conditions such as syphilis, rubella, amyloidosis, and neurofibromatosis.…”

“…7,8 Surgical treatment is challenging and can result in highly morbid complications and death, while extensive and circumferential calcification lurks difficulties for endovascular therapy. 4 However, there is general acceptance that the surgical open technique is associated with high rates of perioperative mortality (8.7-11.6%) and serious postoperative complications. 9,10 A newer alternative technique is stent-graft placement, especially in selected patients.…”

“…Almost 40 years later, the pathophysiological causative factor remains uncertain, although the most likely hypothesis is the secondary calcification of a thrombus and the implication of inhibitions of insufficient calcification such as serum fetuin-A and uncarboxylated matrix Gla protein. 4 5…”

Novel use of intravascular lithotripsy for coral reef aorta: a case report

“…There are a few case reports of the use of bare stent or covered stent-grafts for CRA where the obstructions were in supra or infrarenal aorta with good landing zones and no involvement of visceral or renal arteries. 7 , 8 There is only one case report of the use of covered endovascular repair of the paravisceral CRA where the chimney-tube-snorkel combination was successfully deployed to treat superior mesenteric artery, CRA, and left renal artery respectively. 9 Our patient had juxtarenal CRA and bilateral renal artery involvement.…”

Balloon-expandable stent graft for coral reef aorta

“… 4 , 5 EVT with a bare metal stent and self-expanding stent graft (SESG) for CRA has been performed recently. 6 , 7 However, SESGs may not be fully expandable owing to a lack of luminal capacity and have a risk of late recoiling. 7 , 8 The VIABAHN VBX BESG has demonstrated technical success and good patency for iliac atherosclerotic lesions.…”