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Published on: December 11, 2017
Very long-term follow-up after aortic stenting for coarctation of the aorta
Manuel Pan1, Cristina Pericet2, Rafael González-Manzanares2
1Servicio de Cardiología, Hospital Universitario Reina Sofía, Córdoba, Spain; Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain; Universidad de Córdoba, Córdoba, Spain.
Insights
Late complications after aortic coarctation stenting are common, especially in younger patients. Higher reintervention rates in children treated with stenting highlight the need for ongoing surveillance.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Pediatric Cardiology
Background:
- Stent implantation is a primary treatment for aortic coarctation (CoA) in older children and adults.
- Long-term outcomes and very late events following CoA stenting require further investigation.
Purpose of the Study:
- To determine the incidence of very late adverse events after aortic coarctation stenting.
- To identify risk factors associated with these late events.
Main Methods:
- A retrospective analysis of 167 patients with aortic coarctation who underwent stent implantation between 1993 and 2018.
- Regular outpatient follow-up including computed tomography (CT) and fluoroscopy assessments.
Main Results:
- Aortic aneurysm occurred in 13% of patients, associated with PALMAZ stent and stented length.
- Stent fracture was observed in 34%, linked to younger age and male sex, but not aneurysm.
- Reintervention rates were 10% in adults and 43% in those treated younger than 12 years.
Conclusions:
- Long-term stenting for aortic coarctation is associated with a significant rate of late complications.
- Younger age at treatment is a predictor of higher reintervention rates due to recoarctation and somatic growth.
- Regular imaging surveillance is recommended for patients treated with aortic coarctation stenting.
Introduction And Objectives:
Stent implantation is the preferred treatment in older children and adults with aortic coarctation (CoA). We aimed to determine the incidence of very late events after CoA stenting.
Methods:
We analyzed a cohort of CoA patients who underwent stent implantation at our center between 1993 and 2018. Patients were periodically followed up in outpatient clinics, including computed tomography (CT) and fluoroscopy assessment.
Results:
A total of 167 patients with CT and fluoroscopy data were included: 83 (49.7%) were aged ≤ 12 years and 46 (28%) were female. The mean clinical follow-up time was 17±8 (range 4-30) years and the mean time to CT/fluoroscopy was 11±7 years. Aortic aneurysm was present in 13% and was associated with the PALMAZ stent (OR, 3.09; 95%CI, 1.11-9.49; P=.036) and the stented length (OR, 0.94; 95%CI, 0.89-0.99; P=.039). Stent fracture was frequent (34%), but was not related to the presence of aneurysm. Stent fracture was associated with young age (OR, 3.57; 95%CI, 1.54-8.33; P=.003), male sex (OR, 4.00; 95%CI, 1.51-12.5, P=.008) and inversely with the PALMAZ stent (OR, 0.29; 95%CI, 0.12-0.67, P=.005). Reintervention was lower in adults (10%), mainly related to aneurysms. Those treated when aged ≤ 12 years had higher reintervention rates (43%) due to recoarctation somatic growth.
Conclusions:
This long-term follow-up study of CoA patients treated with stenting revealed a significant incidence of late events. Reintervention rates were higher in patients treated at younger ages. Periodic imaging surveillance appears to be advisable.
