Intermediate follow-up following intravascular stenting for treatment of coarctation of the aorta.

Abstract

BACKGROUND:

We report a multiinstitutional study on intermediate-term outcome of intravascular stenting for treatment of coarctation of the aorta using integrated arch imaging (IAI) techniques.

METHODS AND RESULTS:

Medical records of 578 patients from 17 institutions were reviewed. A total of 588 procedures were performed between May 1989 and Aug 2005. About 27% (160/588) procedures were followed up by further IAI of their aorta (MRI/CT/repeat cardiac catheterization) after initial stent procedures. Abnormal imaging studies included: the presence of dissection or aneurysm formation, stent fracture, or the presence of reobstruction within the stent (instent restenosis or significant intimal build-up within the stent). Forty-one abnormal imaging studies were reported in the intermediate follow-up at median 12 months (0.5-92 months). Smaller postintervention of the aorta (CoA) diameter and an increased persistent systolic pressure gradient were associated with encountering abnormal follow-up imaging studies. Aortic wall abnormalities included dissections (n = 5) and aneurysm (n = 13). The risk of encountering aortic wall abnormalities increased with larger percent increase in CoA diameter poststent implant, increasing balloon/coarc ratio, and performing prestent angioplasty. Stent restenosis was observed in 5/6 parts encountering stent fracture and neointimal buildup (n = 16). Small CoA diameter poststent implant and increased poststent residual pressure gradient increased the likelihood of encountering instent restenosis at intermediate follow-up.

CONCLUSIONS:

Abnormalities were observed at intermediate follow-up following IS placement for treatment of native and recurrent coarctation of the aorta. Not exceeding a balloon:coarctation ratio of 3.5 and avoidance of prestent angioplasty decreased the likelihood of encountering an abnormal follow-up imaging study in patients undergoing intravascular stent placement for the treatment of coarctation of the aorta. We recommend IAI for all patients undergoing IS placement for treatment of CoA.

• Authors: Thomas J Forbes, Phillip Moore, Carlos A C Pedra, Evan M Zahn, David Nykanen, Zahid Amin, Swati Garekar, David Teitel, Shakeel A Qureshi, John P Cheatham, Makram R Ebeid, Ziyad M Hijazi, Satinder Sandhu, Donald J Hagler, Horst Sievert, Thomas E Fagan, Jeremy Ringwald, Wei Du, Liwen Tang, David F Wax, John Rhodes, Troy A Johnston, Thomas K Jones, Daniel R Turner, Robert Pass, Alejandro Torres, William E Hellenbrand
• Journal: Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions (Catheter Cardiovasc Interv) Vol. 70 Issue 4 Pg. 569-77 (Oct 01 2007) ISSN: 1522-1946 [Print] United States
• PMID: 17896405 (Publication Type: Journal Article, Multicenter Study)
• Copyright: (c) 2007 Wiley-Liss, Inc.

Topics

• Adolescent
• Adult
• Aortic Dissection (diagnostic imaging, etiology, pathology)
• Angioplasty, Balloon (adverse effects, instrumentation)
• Aorta, Thoracic (diagnostic imaging, pathology)
• Aortic Aneurysm (diagnostic imaging, etiology, pathology)
• Aortic Coarctation (diagnostic imaging, pathology, therapy)
• Aortography (methods)
• Brazil
• Cardiac Catheterization
• Child
• Constriction, Pathologic (diagnostic imaging, etiology, pathology)
• Europe
• Follow-Up Studies
• Humans
• Magnetic Resonance Angiography
• Practice Guidelines as Topic
• Prosthesis Failure
• Research Design
• Retrospective Studies
• Stents
• Time Factors
• Tomography, X-Ray Computed
• Treatment Outcome
• United States