Endovascular Management of Aortic Coarctation Using Innovative Stent Technology

Aortic coarctation (AC) is a congenital defect characterized by a narrowing of the aorta usually near the left subclavian artery. Repair has traditionally been performed via an open approach, but off label endovascular options have emerged for treatment of patients diagnosed in adolescence or adulthood. Complications related to percutaneous ballooning and stenting have been recognized such as aortic dissection, rupture, and embolization. The gap in existing technology has led to the development of a covered balloon expandable stent with balloon in balloon (BIB) technology with specific indication for treatment of AC.

This report is a single-center, retrospective review of 11 consecutive adult patients treated with the Cheatham- Platinum stent. Primary indications for intervention were hypertension, pseudoaneurysm, aortic insufficiency, and claudication. Five patients had prior aortic intervention (3 open repair, 2 off-label aortic endografts). Rapid ventricular pacing was used for all deployments.

Mean lengths of treated lesions were 5.4 +/- 1.8 mm with mean aortic diameters of 7.6 +/- 1.2 mm located 26.1 +/- 4.0 mm distal to the left subclavian artery. Technical success was reported in all 11 patients with improvement of pressure gradient from 33.6 +/- 9.1 mmHg pre procedure to < 5 mmHg in all cases. All but two patients experienced improved blood pressure control. No adverse events were reported. The median length of stay was 1 day. Mean follow up was 25.3 +/- 7.55 months with no recurrences.

This midterm data is supportive of the use of covered balloon expandable stents with BIB technology as a safe and effective treatment option for AC. Expanded indications of this device are likely feasible.