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Endovascular stents for coarctation of the aorta: initial results and intermediate-term follow-up
M A Hamdan1, S Maheshwari, J T Fahey
1Section of Pediatric Cardiology, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA.
Insights
Endovascular stent placement effectively treats coarctation of the aorta (CoA), both native and recurrent. This minimally invasive approach significantly reduces pressure gradients and improves aortic dimensions with excellent short-term results.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Pediatric Cardiology
Background:
- Coarctation of the aorta (CoA) is a congenital heart defect requiring intervention.
- Endovascular stents offer a less invasive alternative to surgery or balloon angioplasty for CoA.
- Previous studies show success with stents in various vascular applications.
Purpose of the Study:
- To evaluate the efficacy and safety of endovascular stent implantation for native and recurrent coarctation of the aorta.
- To assess the impact of stenting on pressure gradients and aortic dimensions.
- To determine the short- and intermediate-term outcomes of stent placement in CoA patients.
Main Methods:
- A cohort of 34 patients (13 native, 21 recurrent CoA) underwent attempted stent implantation.
- Successful outcome was defined as a post-procedure peak systolic pressure gradient < 20 mm Hg.
- Follow-up included imaging and hemodynamic assessments to evaluate outcomes and complications.
Main Results:
- Stent implantation was successful in 33 of 34 patients, with 32 achieving the primary success endpoint.
- Significant reduction in peak systolic pressure gradient (32 to 4 mm Hg) and increase in aortic diameter ratio (0.46 to 0.92) were observed.
- Complications occurred in 6% of patients; no late stent displacement, fracture, or aneurysm formation was noted during follow-up (mean 29 months).
- Systolic blood pressure and pressure gradients significantly decreased post-stenting and at follow-up.
Conclusions:
- Endovascular stent placement provides excellent short- and intermediate-term results for native and recurrent coarctation of the aorta.
- Stenting is a safe and effective treatment option, leading to significant hemodynamic improvement.
- Long-term outcomes require further investigation to fully establish the durability of stent repair in CoA.
Objectives:
The aim of this study was to evaluate the use of endovascular stents in native and recurrent coarctation of the aorta (CoA).
Background:
Stents have been used successfully in various locations. Their use in CoA can be an alternative to surgery or balloon angioplasty (BA).
Methods:
Thirty-four patients with CoA (13 native and 21 re-coarctation after surgery or BA) with a mean age of 16 +/- 8 years (range 4 to 36 years) underwent attempted stent implantation between 1993 and 1999. Successful outcome was defined as peak systolic pressure gradient after stent implantation < 20 mm Hg.
Results:
Stents were implanted in 33/34 patients, and successful outcome occurred in 32/33 patients. Peak systolic pressure gradient decreased from 32 +/- 12 mm Hg to 4 +/- 11 mm Hg (p < 0.001). Coarctation site to descending aorta diameter ratio increased from 0.46 +/- 0.16 to 0.92 +/- 0.16 (p < 0.001). Two patients underwent successful stent re-dilation 16 and 21 months after initial implantation. Six patients (18%) developed complications, including two patients who underwent surgery. Follow-up for 29 +/- 17 months (range: 5 to 81 months) demonstrated no evidence of re-coarctation, aneurysm formation, stent displacement or fracture. Systolic blood pressure (SBP) decreased from 136 +/- 21 mm Hg before stent placement to 122 +/- 19 mm Hg at follow-up (p = 0.002). The SBP gradient decreased from 39 +/- 18 mm Hg to 4 +/- 6 mm Hg, and peak Doppler gradient decreased from 51 +/- 26 mm Hg to 13 +/- 11 mm Hg at follow-up (p < 0.001).
Conclusions:
Intravascular stent placement for native and recurrent CoA has excellent results in the short and intermediate terms. Long-term outcome remains to be evaluated.
