Coarctation of the aorta: stenting in children and adults
Alex B Golden1, William E Hellenbrand
1Children's Hospital of New York, New York Presbyterian Hospital, Columbia Campus, New York, USA. alexgoldenmd@gmail.com
Insights
Balloon-expandable stents offer a safe and effective treatment for coarctation of the aorta, with high success rates and manageable complications. This approach is a valuable alternative for many patients requiring intervention for this condition.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Pediatric Cardiology
Background:
- Coarctation of the aorta is a congenital heart defect requiring timely intervention to prevent severe health consequences.
- Advances in interventional cardiology have led to less invasive treatment options.
- Balloon-expandable stents have emerged as a viable alternative to surgical repair and angioplasty.
Purpose of the Study:
- To provide a practical guide for stenting coarctation of the aorta.
- To review techniques and technical considerations for this procedure.
- To assess the safety and efficacy of balloon-expandable stents for coarctation of the aorta.
Main Methods:
- Retrospective analysis of 588 stent placements for coarctation of the aorta.
- Data collected from 1989 to 2005 by the Congenital Cardiovascular Interventional Study Consortium (CCISC).
- Evaluation of procedural success defined by gradient reduction or diameter ratio improvement.
Main Results:
- High procedural success rate of 98.6% (580/588 procedures).
- Overall complication rate of 11.7% (69/588 cases), with common issues including femoral access vessel problems, aneurysm formation, aortic dissection, and cerebrovascular accidents.
- Low procedure-related mortality rate of 0.3% (2/588 cases).
Conclusions:
- Balloon-expandable stent placement is a safe and highly effective treatment for a significant number of patients with coarctation of the aorta.
- This interventional approach offers a valuable alternative to traditional surgical methods.
- Careful patient selection and procedural technique are crucial for optimizing outcomes and minimizing complications.
Abstract:
Coarctation of the aorta may present in infants, children, or adults, and it requires treatment to prevent serious morbidity and mortality. Recent advances in equipment and a growing collective experience have made placement of balloon-expandable stents a safe and effective alternative to surgery or angioplasty in a growing range of patients. This review seeks to provide a working aid for stenting of coarctation of the aorta, based on the techniques and technical considerations in practice at our institution. Between 1989 and 2005, the Congenital Cardiovascular Interventional Study Consortium (CCISC), a consortium of 17 centers, of which our institution is the largest contributor, performed 588 stent placements for coarctation of the aorta. Of the 588 procedures, 580 (98.6%) were successful, as defined by reduction of the gradient to less than 20 mm Hg or increase of the ratio of the diameter of the coarctation area (CoA) to the diameter of the descending aorta (DAo) to at least 0.8. There were a total of 84 complications occurring in 69/588 (11.7%) cases. The most common significant complications were femoral access vessel related 15/588 (2.6%), aneurysm formation 13/588 (2.2%), aortic dissection 9/588 (1.5%), and cerebrovascular accident 6/588 (1.0%). There were two procedure-related deaths (0.3%) recorded in the 16-year period. Many of these significant complications occurred in the same patients. Balloon-expandable stents should be considered a safe and very effective treatment modality in a significant subset of patients with coarctation of the aorta.
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