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Evaluating the Effectiveness of Stenting for Aortic Coarctation
Constantinos Contrafouris1, Constantine N Antonopoulos2, Spyridon Rammos3
11st Cardiac Surgery Department, "Onassis" Cardiac Surgery Center, Athens, Greece.
Insights
Endovascular stenting effectively treats coarctation of the aorta (CoA), improving aortic diameter and blood pressure gradients. Both bare and covered stents showed similar positive hemodynamic effects in patients with CoA.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Engineering
Background:
- Coarctation of the aorta (CoA) is a congenital narrowing of the thoracic aorta.
- This condition requires effective treatment to prevent cardiovascular complications.
Purpose of the Study:
- To evaluate the hemodynamic effects of endovascular treatment for coarctation of the aorta (CoA).
- To compare the efficacy of bare (bCP) versus covered (cCP) Cheatham-Platinum stents in CoA treatment.
Main Methods:
- Retrospective evaluation of 47 patients with CoA treated with stent implantation (2003-2019).
- Invasive aortic pressure measurements were recorded before and after endovascular intervention.
- Comparison of hemodynamic outcomes between bCP and cCP stent groups.
Main Results:
- Endovascular stenting significantly increased aortic diameter at the CoA lesion (9.7 to 19.2 mm).
- Mean blood pressure in the descending aorta increased, while in the ascending aorta it decreased post-intervention.
- Both bCP and cCP stents effectively reduced the mean aortic blood pressure gradient, with no significant difference between stent types.
Conclusions:
- Invasive aortic catheterization confirms the efficiency of endovascular stenting for treating coarctation of the aorta.
- Both bare and covered Cheatham-Platinum stents are effective treatment options for CoA, yielding similar hemodynamic improvements.
Background:
Coarctation of the aorta (CoA) is a congenital cardiovascular malformation involving narrowing of the thoracic aorta just distal to the left subclavian artery. The aim of our study was to evaluate the hemodynamic effects of endovascular treatment for CoA by using invasive aortic catheterization.
Methods:
All patients with CoA who underwent treatment by aortic stent implantation between September 1, 2003, and February 1, 2019, at the "Onassis Cardiac Surgery Center," in Athens, Greece, were evaluated. Patients were treated with either bare (uncovered) Cheatham-Platinum (bCP) or covered Cheatham-Platinum (cCP) stent implantations. Invasive aortic pressure measurements were recorded before and after the endovascular intervention.
Results:
A total of 48, eight zig CP stents, comprising 24 bCP and 24 cCP stents were implanted in 47 patients. The mean aortic diameter (mm) at the CoA lesion increased from 9.7 ± 3.3 to 19.2 ± 2.9 mm (p <0.01) after the endovascular procedure. The invasive mean blood pressure (BP; mm Hg) from catheterization in the descending aorta increased (before = 114.2 ± 12.8 vs. after = 135.5 ± 28.1; p <0.01), while the invasive mean BP (mm Hg) from catheterization in the ascending aorta was decreased (before = 156.8 ± 25.0 vs. after = 138.4 ± 27.5; p <0.01) after the intervention. The mean aortic BP gradient decreased in both types of stents after intervention (BP gradient among patients with cCP stents = 30.9 +/- 23.6 mmHg and BP gradient among patients with bCP stents = 38.0 +/-23.1 mmHg). However, there was no statistically significant difference between the two types of stents; p = 0.36.
Conclusions:
Invasive aortic catheterization provided evidence that endovascular stenting with either bare or covered stents is efficient in treating patients with CoA.
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