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Coarctation of aorta intervention: When covered stents should have been first choice?
Palanivel Rajan1, Navjyot Kaur1, Parag Barwad1
1Department of Cardiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Insights
Covered stents are crucial for high-risk coarctation of the aorta (CoA) cases, offering better outcomes than balloon angioplasty in specific complex scenarios. These advanced interventions address complications and re-coarctation effectively.
Area of Science:
- Cardiology
- Interventional Cardiology
- Congenital Heart Disease
Background:
- Coarctation of the aorta (CoA) is a common congenital heart defect requiring intervention.
- Transcatheter (TC) stenting is preferred over balloon angioplasty for CoA intervention.
- Two stent types exist: balloon-expandable and covered stent-grafts.
Observation:
- Elective covered stent use in all CoA cases offers no clear advantage.
- Covered stents are indicated in specific complex CoA situations, beyond acute aortic complications.
- Case series highlights three CoA interventions where covered stenting was the preferred choice.
Findings:
- A patient with Turner's syndrome and severe CoA developed dissection post-balloon angioplasty, successfully treated with a covered stent.
- A patient with near-aortic atresia had an underexpanded balloon-expandable stent.
- A patient with severe CoA and PDA developed re-coarctation, managed with a covered stent.
Implications:
- Covered stents are the first-choice intervention for certain high-risk CoA cases.
- This approach can prevent or manage complications like dissection and re-coarctation.
- Tailoring stent choice to CoA complexity improves patient outcomes.
Abstract:
Coarctation of aorta (CoA) is one of the common congenital heart diseases. The two approaches for intervention in CoA include surgical and transcatheter (TC). Out of the two TC interventions available, stenting has been proved better than balloon angioplasty. We have two types of stents; the conventional ones - balloon expandable and the covered stent grafts. The elective covered stent implantation in all CoA has not offered any advantage. However, there are peculiar situations, apart from acute aortic complications, when they should be considered the first choice. We describe our experience of three cases of coarctation stenting, in which covered stenting should have been the preferred choice. A 32-year-old female with Turner's syndrome and severe CoA developed dissection after balloon angioplasty which was successfully managed with a covered stent. A 27-year-old female with near atresia of aorta was managed with balloon expandable stent which remained underexpanded despite post dilatation. A 17-year-old girl with severe CoA and patent ductus arteriosus (PDA) was managed with balloon angioplasty for the CoA and Amplatzer Duct Occluder I for the PDA. However, she developed re-coarctation in 6 months which was managed with a covered stent. Not all CoA requires the covered stents, but there are certain "high risk" CoA which require covered stent as first choice.
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