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Stenting complex aortic arch obstructions.

Ralf J Holzer1, Joanne L Chisolm, Sharon L Hill

  • 1The Heart Center, Columbus Children's Hospital, Columbus, Ohio 43205, USA. rholzer@chi.osu.edu

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|February 22, 2008
PubMed
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Endovascular stent therapy effectively treats complex aortic arch lesions, significantly reducing gradients and hypertension. Patients under 10 kg or post-Hybrid stage I palliation face higher risks.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Pediatric Cardiology

Background:

  • Aortic arch obstructions present complex management challenges.
  • Physicians often hesitate to treat mild-moderate lesions or opt for high-risk surgery.
  • Data on transcatheter stent therapy for complex aortic arch lesions are limited.

Purpose of the Study:

  • To evaluate the institutional experience with endovascular stent therapy for complex aortic arch lesions.
  • To assess the safety and efficacy of stent implantation in this patient population.

Main Methods:

  • Retrospective analysis of 40 patients undergoing 42 stent implantation procedures for complex aortic arch lesions between 2002 and 2006.
  • Aortic arch hypoplasia was present in 71.4% of procedures.

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  • Patients had a median age of 10 years, with 95.2% having prior interventions.

    • Main Results:

    • Procedural success (gradient or=90% normal) was achieved in 90.5% of procedures.
    • Median arch obstruction diameter increased from 7.55 mm to 14 mm (P < 0.0001).
    • Peak systolic gradient reduced from 23 mm Hg to 2 mm Hg (P < 0.0001), and systemic hypertension decreased significantly at follow-up (52.4% to 15.4%, P = 0.0005).
    • Adverse events occurred in 30.9%, particularly in patients <10 kg or with univentricular physiology.

    Conclusions:

    • Endovascular stenting is a safe and effective treatment for complex aortic arch lesions, yielding excellent immediate and midterm outcomes.
    • Patients <10 kg or post-Hybrid stage I palliation are at increased risk for adverse events.
    • Stent placement across major arch vessels is feasible without compromising distal perfusion in normal vasculature.