Acute and medium term results of balloon expandable stent placement in the transverse arch—a multicenter pediatric interventional cardiology early career society study

Abstract

Objectives and Background: Coarctation of the aorta represents 5-8% of all congenital heart disease. Although balloon expandable stents provide an established treatment option for native or recurrent coarctation, outcomes from transverse arch (TAO) stenting, including resolution of hypertension have not been well studied. This study aims to evaluate immediate and midterm results of TAO stenting in a multicenter retrospective cohort. Methods: TAO stenting was defined as stent placement traversing any head and neck vessel, with the primary intention of treating narrowing in the transverse aorta. Procedural details, complications and medications were assessed immediately post procedure, at 6 month follow-up and at most recent follow-up. Results: Fifty-seven subjects, 12 (21%) native, and 45 (79%) surgically repaired aortic arches, from seven centers were included. Median age was 14 years (4 days-42 years), median weight 54 kg (1.1-141 kg). After intervention, the median directly measured arch gradient decreased from 20 mmHg (0-57 mmHg) to 0 mmHg (0-23 mmHg) (p < .001). The narrowest arch diameter increased from 9 mm (1.4-16 mm) to 14 mm (2.9-25 mm) (p < .001), with a median increase of 4.9 mm (1.1-10.1 mm). One or more arch branches were covered by the stent in 55 patients (96%). There were no serious adverse events. Two patients warranted stent repositioning following migration during deployment. There were no late complications. There were 8 reinterventions, 7 planned, and 1 unplanned (6 catheterizations, 2 surgeries). Antihypertensive management was continued in 19 (40%) at a median follow-up of 3.2 years (0.4-7.3 years). Conclusions: TAO stenting can be useful in selected patients for resolution of stenosis with minimal complications. This subset of patients are likely to continue on antihypertensive medications despite resolution of stenosis.

Transverse arch stenting and its effect on systemic hypertension

“…Similar to findings in other studies, we observed a statistically significant decrease in systemic blood pressure, pressure gradient through the aorta, and an increase in TAA diameter. [5,9,10] In our study, all patients were hypertensive before the TAA stenting procedure. However, the proportion of normotensive patients increased following stent implantation, with eight (44%) of 18 patients achieving a normotensive state during the follow-up period (Figure 6).…”

“…There are few studies on TAA stenting in the literature. [5,[9][10][11] The present study comprehensively evaluated this intervention from a technical standpoint and its effect on hypertension. Stent implantation was successfully performed in all patients, with no reported mortality or major complications during the acute period.…”

“…Similar to findings in other studies, we observed a statistically significant decrease in systemic blood pressure, pressure gradient through the aorta, and an increase in TAA diameter. [ 5 , 9 , 10 ]…”

“…[ 5 ] A limited number of studies exist about stent implantation in TAA lesions. [ 5 , 9 , 10 ] This study focused on two main points: investigating the safety, efficacy, and outcomes of aortic arch stenting and evaluating the course of hypertension, blood pressure changes, assessed medication requirements, and the act of arch stenting to systemic hypertension.…”

Challenges in diagnosis and management of coarctation of the aorta

“…The evolution of interventional techniques for management of coarctation of the aorta requires a separate review of this evolving field but we highlight a few recent developments. With increasing experience with interventional techniques, they have been applied to novel patient groups including balloon angioplasty for low-birth-weight premature infants [37 ▪ ], balloon angioplasty using axillary access for critically ill newborns [38 ▪ ], stenting for selected children under 3 months of age [39 ▪ ], and stenting for arch hypoplasia [40 ▪ ,41 ▪ ]. There are promising results of stent implantation being performed in younger children less than 12 kg [42] and less than 20 kg [43].…”