Self-expanding and balloon expandable covered stents in the treatment of aortic coarctation with or without aneurysm formation.

Abstract

OBJECTIVES:

We describe our complete experience with covered stent implantation for aortic coarctation including short- to medium-term outcomes.

BACKGROUND:

Coarctation of the aorta is a heterogeneous disease process with multiple associated complications both with and without treatment. Covered stents have evolved to provide greater support to the aortic wall and a varied approach with choice of stent tailored to the anatomy of the patient is required.

METHODS:

We retrospectively analyzed consecutive patient data from two congenital heart centers from March 2003 to October 2007.

RESULTS:

We implanted 38 covered stents in 37 patients (20 female) of which three were self-expanding stents. Median age was 29.6 years (9-65) with median weight of 71.5 kg (35-95). The indications for stent placement were native coarctation (n = 13); recurrent coarctation following surgical treatment (n = 11); aneurysm associated with previous coarctation surgery (n = 7); aorto-bronchial fistula leading to acute hemoptysis (n = 2); stent fracture (n = 1); associated arterial duct (n = 2). One patient had a combination of acquired coarctation and false aneurysm. The median screening time was 10 min (3-22). The median systolic gradient of 26 mm Hg (10-60) was reduced to 4 mm Hg (0-20) postprocedure (P < 0.001). There were no deaths on median follow up of 11.5 months (1-56). One patient developed aortic rupture during the procedure and required emergency surgery.

CONCLUSION:

Covered stent implantation for treatment of aortic coarctation is safe and highly effective in selected patients. Self-expanding stent grafts may be preferable to balloon expandable stents when there is aneurysm formation in the setting of aortopathy.

• Authors: Damien Kenny, Ronan Margey, Mark S Turner, Andrew J Tometzki, Kevin P Walsh, Robin P Martin
• Journal: Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions (Catheter Cardiovasc Interv) Vol. 72 Issue 1 Pg. 65-71 (Jul 01 2008) ISSN: 1522-726X [Electronic] United States
• PMID: 18412235 (Publication Type: Journal Article)

Chemical References

• Coated Materials, Biocompatible
• Polyesters
• Polytetrafluoroethylene

Topics

• Adolescent
• Adult
• Aged
• Angioplasty, Balloon, Coronary
• Aortic Aneurysm (complications, therapy)
• Aortic Coarctation (complications, therapy)
• Child
• Coated Materials, Biocompatible
• Cohort Studies
• Equipment Design
• Female
• Humans
• Male
• Middle Aged
• Polyesters
• Polytetrafluoroethylene
• Retrospective Studies
• Stents
• Treatment Outcome