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Endovascular aortic coarctation stenting in adolescents and adults: angiographic and hemodynamic outcomes
Vaikom S Mahadevan1, Isabelle F Vondermuhll, Michael J Mullen
1Adult Congenital Heart Unit, Royal Brompton Hospital, London, SW3 6NP, United Kingdom. viakom.mahadevan@cmmc.nhs.uk
Insights
Primary stenting for aortic coarctation in adolescents and adults significantly reduces blood pressure and gradients at 1 year. Close monitoring is needed for potential aneurysm formation post-procedure.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Pediatric Cardiology
Background:
- Stenting is a common treatment for aortic coarctation.
- Limited data exists on the 1-year efficacy of stenting for hypertension control.
- The impact of newer stent types on outcomes is not well-established.
Purpose of the Study:
- To evaluate procedural, clinical, angiographic, and hemodynamic outcomes of primary stenting for aortic coarctation.
- To assess ambulatory blood pressure at 1 year post-procedure.
- To compare outcomes between different stent types.
Main Methods:
- Observational study of 37 adolescent and adult patients undergoing primary stenting for aortic coarctation.
- Data collected over a 3-year period in a tertiary care center.
- Follow-up included angiography and ambulatory blood pressure monitoring at 1 year.
Main Results:
- Significant reduction in peak gradient across the coarctation from baseline to 1 year (28.3 to 11.9 mmHg).
- Systolic blood pressure decreased significantly at 6 weeks and 1 year.
- One major complication (2.7%) and no deaths; small aneurysms observed in 13% at 1-year angiography.
Conclusions:
- Primary stenting of aortic coarctation yields excellent clinical and angiographic results.
- Sustained hemodynamic benefits, including reduced blood pressure and gradients, are observed at 1 year.
- Regular follow-up is essential to monitor for aneurysm development.
Objectives:
To assess the procedural, clinical, angiographic, and hemodynamic outcomes, including ambulatory blood pressure monitoring at 1 year in adolescent and adult patients undergoing primary stenting for treatment of aortic coarctation.
Background:
Stenting is widely used for treatment of aortic coarctation. Data regarding efficacy of this treatment for control of hypertension at 1 year is scant, with only one reported series of planned angiographic follow up. The impact of newer type stents for this procedure is also unknown.
Methods:
Thirty-seven patients undergoing stenting for aortic coarctation, over a 3-year period in a tertiary centre were studied as part of an observational protocol.
Results:
Peak gradient across the coarctation fell from 28.3 +/- 15.1 to 3.7 +/- 4.1 post procedure and was 11.9 +/- 8.9 mmHg (P < 0.05 compared to baseline) at 1 year. There was one major complication (2.7%), with no deaths. Small aneurysms were seen in three patients (13%) on follow up angiography at 1 year. Right arm systolic blood pressures fell from 155 +/- 19 to 132 +/- 22 (P < 0.05) at 6 weeks and was 132 +/- 16 mmHg (P < 0.05 compared to baseline) at 1 year. Ambulatory average systolic blood pressures fell from 142 +/- 14 to 133 +/- 15 at 6 weeks (P < 0.05) and to 125 +/- 12 mmHg (P < 0.05 compared to baseline) at 1 year. No significant differences were seen in procedural outcomes between patients receiving Palmaz and CPNumed stents.
Conclusion:
Primary stenting of aortic coarctation in adolescents and adults results in excellent clinical and angiographic outcomes and sustained hemodynamic benefits at 1 year as evidenced by significant reduction in systolic blood pressure and gradients. Close follow up is required to monitor aneurysm formation.
