Hazard in ductal stenting: helicoid open cell stents

Stent implantation in the arterial duct has achieved great acceptance as an alternative to an aortopulmonary shunt procedure. Despite challenging, also tortuous arterial ducts as in ToF and pulmonary atresia with VSD can be addressed, since flexible open cell coronary stents are available. We describe two patients with ToF and Ebstein's anomaly where a special helicoid open cell stent was implanted to cross a highly stenotic sigmoid arterial duct. In both patients, the stent design resulted in extremely kinked stent segments with minor or absent flow through the stent lumen. While in one patient early ToF-repair was required, in the other recrossing and restenting with another open cell but not helicoid tubular design type of stent allowed adequate pulmonary perfusion. Although mimicking of the natural course even in tortuous ducts is not mandatory, kinking of the stent is likely to occur in these types of arterial ducts. On the basis of our experience, we can not recommend helicoid manufactured stents in the scenario of ductal stenting, especially in congenital heart disease with completely duct dependent pulmonary circulation.