Intentional Stent Fracture to Accommodate Growth After Coarctation Stenting in an 860-g Neonate

Congenital aortic coarctation in neonates and children can be managed with transcatheter stent implantation, but this approach raises the issue of how to accommodate the fixed stent structure within the growing vessel.

A 15-month-old boy, born prematurely with critical aortic coarctation, was treated at 1 week of age with the implantation of a coronary stent. Subsequently, multiple stent dilatations were needed to adapt it to the growing aortic vessel. At 3 months the patient underwent balloon dilation with the simultaneous implantation of a second stent, and after 1 year an ultra-high-pressure balloon dilatation with intentional fracture of the coronary stent was performed.

To overcome the problem of stenting a growing vessel, intentional stent fracture (ISF) with ultrahigh-pressure (UHP) balloon has been introduced and applied in a limited number of patients. In piglet models, the ISF technique was associated with a significant incidence of complications, which were preventable (with the exception of stent fragment embolization) by performing pre-stenting before ISF.