Use of Endovascular Stents for the Treatment of Coarctation
The aim of this study was to evaluate the use of endovascular stents in both native and recurrent coarctation of the aorta (CoA) in children and adults. Background. The use of stents in CoA as an alternative to surgery or balloon angioplasty has been shown to have favorable immediate and midterm results. Methods. Between May 1995 and February 2005, 44 patients (28 native and 16 with re-coarctation after previous intervention) at a mean age of 16.9 ± 1.8 years (range 3 months–44 years) underwent stent implantation. Successful outcome was defined as a reduction in the peak systolic pressure gradient by 50% or more. Results. Stents were implanted in all 44 patients and successful outcomes occurred in all 44 patients. The peak systolic gradient decreased from a mean value of 29.2 ± 1.9 mmHg (range from 7– 55 mmHg) to a mean of 3.7 ± 0.7 mmHg (range from 0–18 mmHg). Coarctation site diameter increased from a mean of 6.1 ± 0.5 mm to a mean of 13 ± 0.5 mm. Twelve patients underwent stent re-dilatation/repeat stent placement procedures between 7–47.5 months after the initial procedure. One patient underwent a repeat procedure after 1 day secondary to stent migration from the first procedure. Complications occurred in 9 patients, of which no patients required surgery. At a mean follow-up of 19.8 ± 3.5 months (range 0.1 to 117 months), 1 patient developed an aneurysm at the site of stent implantation. This patient is awaiting surgical repair of the aneurysm. No other complications were noted. Therefore, we conclude that stent implantation for coarctation of the aorta is safe and effective with sustained good midterm results.
Coarctation of the aorta (CoA) accounts for 6–8% of all forms of congenital heart defects. In children and adults, balloon angioplasty has become the preferred treatment for patients with recurrent CoA. The application of this technique for treatment of native coarctation is somewhat controversial due to the high incidence of recoarctation (5–10%) and the incidence of aneurysm formation (5–7%). There are few reports in the medical literature documenting the beneficial use of stent implantation for the treatment of CoA. Stent implantation results in less residual gradient across the coarctation site, improved diameter, decreased incidence of aneurysm formation and sustained hemodynamic benefit. In this paper, we report the immediate and midterm results of our experience in two centers by a single operator for percutaneous stent implantation in patients with native or recurrent CoA.
The aim of this study was to evaluate the use of endovascular stents in both native and recurrent coarctation of the aorta (CoA) in children and adults. Background. The use of stents in CoA as an alternative to surgery or balloon angioplasty has been shown to have favorable immediate and midterm results. Methods. Between May 1995 and February 2005, 44 patients (28 native and 16 with re-coarctation after previous intervention) at a mean age of 16.9 ± 1.8 years (range 3 months–44 years) underwent stent implantation. Successful outcome was defined as a reduction in the peak systolic pressure gradient by 50% or more. Results. Stents were implanted in all 44 patients and successful outcomes occurred in all 44 patients. The peak systolic gradient decreased from a mean value of 29.2 ± 1.9 mmHg (range from 7– 55 mmHg) to a mean of 3.7 ± 0.7 mmHg (range from 0–18 mmHg). Coarctation site diameter increased from a mean of 6.1 ± 0.5 mm to a mean of 13 ± 0.5 mm. Twelve patients underwent stent re-dilatation/repeat stent placement procedures between 7–47.5 months after the initial procedure. One patient underwent a repeat procedure after 1 day secondary to stent migration from the first procedure. Complications occurred in 9 patients, of which no patients required surgery. At a mean follow-up of 19.8 ± 3.5 months (range 0.1 to 117 months), 1 patient developed an aneurysm at the site of stent implantation. This patient is awaiting surgical repair of the aneurysm. No other complications were noted. Therefore, we conclude that stent implantation for coarctation of the aorta is safe and effective with sustained good midterm results.
Coarctation of the aorta (CoA) accounts for 6–8% of all forms of congenital heart defects. In children and adults, balloon angioplasty has become the preferred treatment for patients with recurrent CoA. The application of this technique for treatment of native coarctation is somewhat controversial due to the high incidence of recoarctation (5–10%) and the incidence of aneurysm formation (5–7%). There are few reports in the medical literature documenting the beneficial use of stent implantation for the treatment of CoA. Stent implantation results in less residual gradient across the coarctation site, improved diameter, decreased incidence of aneurysm formation and sustained hemodynamic benefit. In this paper, we report the immediate and midterm results of our experience in two centers by a single operator for percutaneous stent implantation in patients with native or recurrent CoA.