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Covered stents in patients with complex aortic coarctations
Gianfranco Butera1, Luciane Piazza, Massimo Chessa
1Pediatric Cardiology, Policlinico San Donato I.R.C.C.S., San Donato Milanese, Italy. gianfra.but@lycos.com
Insights
Covered Cheatham-Platinum stents effectively treated complex aortic coarctation, significantly reducing pressure gradients and increasing vessel diameter. These promising results suggest a valuable new option for patients with this condition.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Medical Devices
Background:
- Limited literature exists on using covered stents for aortic coarctation.
- Aortic coarctation requires effective treatment strategies, especially in complex cases.
Purpose of the Study:
- To evaluate the safety and efficacy of covered Cheatham-Platinum stents in treating complex aortic coarctation.
- To assess the impact of stent implantation on pressure gradients and vessel dimensions.
Main Methods:
- 33 patients with complex aortic coarctation underwent implantation of covered Cheatham-Platinum stents.
- Procedures were performed under general anesthesia with orotracheal intubation.
- Patient data included native coarctation and recoarctation cases, with a wide age range.
Main Results:
- Significant reduction in the pressure gradient across the stenosis (from 39 mm Hg to 0 mm Hg) post-implantation (P < .0001).
- Substantial increase in vessel diameter from 5 mm to 15 mm (P < .0001).
- Stents were correctly positioned with no immediate complications; stenoses relieved and aneurysms excluded.
Conclusions:
- Covered Cheatham-Platinum stents demonstrate promising outcomes for complex aortic coarctation treatment.
- The procedure led to significant hemodynamic and anatomic improvements.
- Long-term follow-up showed stable results, with one case of restenosis successfully managed.
Background:
There are limited data in the literature about the use of covered stent in patients with aortic coarctation.
Methods:
Between January 2004 and September 2006, we implanted covered Cheatham-Platinum stents in 33 patients with complex aortic coarctation (23 men, median age 13 years, range 6-66 years). Twenty subjects had native aortic coarctation, whereas 13 had recoarctation. All procedures were performed under general anesthesia and orotracheal intubation.
Results:
The stents used ranged from 22 to 45 mm in length. The mean fluoroscopy and procedure times were 14 +/- 6 and 74 +/- 15 minutes, respectively. After implantation, the gradient across the stenosis decreased significantly (pre stent: median value 39 mm Hg [range 20-75 mm Hg] vs post stent: median value 0 mm Hg [range 0-12 mm Hg] [P < .0001]). Vessel diameter increased from a median value of 5 mm (range 0-11) to a median value of 15 mm (range 10-25) (P < .0001). The stents were placed in the correct position in all subjects. No complications occurred, and on angiographic control, the stenoses had been relieved and the aneurysms completely excluded. During a median follow-up of 12 months (1-40 months), the results were stable without complications. One patient developed intrastent restenosis due to a significant endothelial proliferation that was successfully treated by high-pressure balloon angioplasty.
Conclusions:
Covered Cheatham-Platinum stents are promising tools for the treatment of complex aortic coarctation.
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