Endovascular Management of Aortic Coarctation Using Innovative Stent Technology

Aortic coarctation (AC) is a congenital defect characterized by 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 the treatment of patients diagnosed in adolescence or adulthood. Complications related to percutaneous ballooning and stenting such as aortic dissection, rupture, and embolization have been recognized. The gap in existing technology has led to the development of a covered balloon-expandable stent with balloon-in-balloon technology with a specific indication for treatment of AC.

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

The treated lesions, with a mean length of 5.4 ± 1.8 mm and a mean aortic diameter of 7.6 ± 1.2 mm, were 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 mm Hg before the procedure to <5 mm Hg in all cases. All but 2 patients experienced improved blood pressure control. No adverse events were reported. The median length of stay was 1 day. Mean follow-up duration was 25.3 ± 7.55 months with no recurrences.

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