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Redilation of e-PTFE covered CP stents
Gianfranco Butera1, Gianpiero Gaio, Mario Carminati
1Department of Pediatric Cardiology, GUCH unit and Cardiac Surgery-Policlinico San Donato IRCCS, San Donato Milanese, Italy. gianfra.but@lycos.com
Insights
Covered Cheatham-Platinum stents can be safely redilated in children with aortic coarctation, allowing for adjustments as they grow. This procedure effectively reduces aortic gradients and restores normal blood flow without complications.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Interventional Radiology
Background:
- Limited literature exists on the redilation of expanded polytetrafluoroethylene (ePTFE) covered Cheatham-Platinum (CP) stents.
- Aortic coarctation in growing children presents challenges due to somatic growth and potential increases in aortic gradients.
Purpose of the Study:
- To assess the feasibility and safety of redilating covered CP stents in patients with aortic coarctation.
- To evaluate the effectiveness of redilation in managing increased aortic gradients and hypertension in pediatric patients.
Main Methods:
- Sixty covered CP stents were implanted for aortic coarctation or recoarctation.
- Seven patients underwent repeat hemodynamic studies due to somatic growth and increased aortic gradients.
- Redilation procedures were performed a mean of 20 months post-implantation.
Main Results:
- Redilation significantly reduced the median gradient across the stenosis from 35 mm Hg to 5 mm Hg.
- Stent diameter increased by 20-50% post-redilation.
- No complications were reported, and angiographic follow-up confirmed relief of stenoses.
Conclusions:
- Covered Cheatham-Platinum stents are amenable to redilation.
- Redilation is a safe and effective option for managing aortic coarctation in growing children.
Objectives:
To evaluate the possibility to redilate covered Cheatham-Platinum stents during follow-up, in particular in growing children with aortic coarctation.
Background:
There are no data in the literature about the redilation of ePTFE covered CP stents.
Methods:
Sixty covered CP stents were implanted in patients with aortic coarctation or recoarctation between January 2004 and October 2007. Seven patients (mean age 14.2 +/- 3.7 years) needed to repeat the hemodynamic study due to somatic growth and increase of aortic gradient with the occurrence of systemic hypertension. Two had near-atretic aortic coarctation, three had postsurgical recoarctation and aneurysm formation, one had native aortic coarctation associated with aneurysm of the arterial wall, and one had severe native aortic coarctation.
Results:
Procedures were performed a mean of 20 +/- 5 months (range, 12-24 months) after the primary stent implantation. Fluoroscopy time ranged between 7 and 15 min (median, 10 min) whereas procedure time ranged between 60 and 75 min (median, 65 min). After redilation the gradient across the stenosis decreased from a median value of 35 mm Hg to a median value of 5 mm Hg. The stent diameter increased of 20-50% the predilation value. No complications occurred and angiographic controls showed that the stenoses have been relieved.
Follow-Up:
During a median follow-up of 12 months (6-30 months) the results were stable without complications.
Conclusion:
Covered Cheatham-Platinum stents can be easily redilated.
