Overlapping covered stents to exclude a postcoarctation stenting aortic aneurysm

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology
• Medical Imaging

Background:

• Patent ductus arteriosus (PDA) and aortic coarctation are congenital heart defects often requiring intervention.
• Stenting for aortic coarctation can lead to re-stenosis and aneurysm formation.
• Adolescent patients with complex cardiovascular histories require specialized management.

Observation:

• An 18-year-old presented with re-stenosis and a large midstent aneurysm after prior PDA coil occlusion and aortic coarctation stenting.
• Cardiac catheterization revealed a significant pressure gradient and a 2 cm x 4.3 cm aneurysm.
• The aneurysm originated at the level of the existing stent.

Findings:

• Two overlapping Cheatham platinum covered stents were successfully implanted to exclude the aneurysm.
• The procedure completely excluded the large mid-stent aneurysm.
• Two-year follow-up with CT angiography demonstrated no endoleak or re-stenosis.

Implications:

• Covered stent implantation is an effective strategy for managing complex aortic coarctation complications like re-stenosis and aneurysms.
• This approach offers a durable solution, preventing endoleak and maintaining stent patency.
• Long-term imaging surveillance is crucial for assessing outcomes in patients with stented aortic coarctation.