Aortic dissection after stent dilatation for coarctation of the aorta: A case report and literature review

Varma, Chetan; Benson, Lee; Butany, Jagdish; McLaughlin, Peter R.

doi:10.1002/ccd.10548

Cited by 80 publications

(52 citation statements)

References 23 publications

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“…Aortic disruption can be a potentially catastrophic complication of CoA stenting (7,22,23). This complication occurred in one of the 45 patients in our study; however, deployment of a second covered stent successfully excluded the area of disruption from the circulation.…”

Section: Discussionmentioning

confidence: 70%

Cheatham-Platinum stent for native and recurrent aortic coarctation in children and adults: immediate and early follow-up results

Erdem¹,

Akdeni̇z²,

Sarıtaş³

et al. 2011

Anadolu Kardiyol Derg

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ÖZETAmaç: Yetişkin ve çocuklarda Cheatham-Platinum stent implantasyonu ile tedavi edilen nativ ve rekürren aort koarktasyonu olgularının erken ve kısa dönem sonuçlarını sunmayı amaçladık. Yöntemler: Ağustos 2007-Kasım 2009 tarihleri arasında 45 hastaya 47 stent yerleştirildi. Koarktasyon tanısı alıp müdahale endikasyonu olan adölesan ve yetişkin hastalarda ilk tercih olarak, 5 yaş üzerindeki çocuklarda ise subatretik veya kör koarktasyon varlığı, önceki tedaviye bağlı anevrizma gelişimi, eşlik eden patent duktus arteriyozus veya yeniden daralma durumlarında stent implantasyonu tercih edildi. Stent implantas- ABSTRACTObjective: To present our institutional experience of endovascular Cheatham-Platinum stent implantation in children and adults with native and recurrent aortic coarctation. Methods: Between August 2007 and November 2009, 45 patients had aortic coarctation treated with 47 stents implantation. We preferred primarily stent implantation in adult patient with coarctation, in children more than five years-old it is preferred in cases of aneurysm, subatretic or blind coarctation and coarctation with patent ductus arteriosus or in restenosis. Files of stent-implanted patients were retrospectively analyzed in terms of patients' demographic features, echocardiographic and angiographic findings both before and after procedure. Patients grouped as Group 1: native coarctation and Group 2: recoarctation developed after either surgery or balloon angioplasty. Findings of the cases' were compared using paired and unpaired Student's t, Mann-Whitney U and Chi-square tests. Results: Sixteen covered and 31 bare totally 47 balloon expandable stents were implanted in 45 patients. The mean follow up duration was 12.1±7.1, median 11 months (2-29 months). There was no procedure related death. In two patients two stents were implanted in tandem. While the coarctation of the aorta was native in 26 patients (functionally interrupted aortic arch in one), recoarctation was detected in 7 patients after surgery, in 8 patients after balloon angioplasty, in 4 patients both after surgery and balloon angioplasty. One patient had functionally interrupted aortic arch perforated with guide wire and then covered stent implanted. The mean age 12.2±5.9 years (5-33 years) and mean body mass index was 21±3.7 kg/m 2 (14.8-31 kg/m 2 ). Considering all cases, a statistically significant decrease in both the invasive and echocardiographic gradients (p<0.001 for both) and statistically significant increase in lesion diameter (p<0.001) were detected. The decrease in invasive and echocardiographic gradients and increase in lesion diameter is statistically significant in each group also (p<0.001, <0.001 and <0.001 for both groups, respectively). Before the procedure, the invasive gradient was significantly higher and the lesion diameter was significantly lower in group I than in group II (p=0.002 and p=0.005, respectively). Also the percentage of decrease in gradient and increase in diameter was statistically higher in group 1 than in group 2 (p=0.04 a...

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Section: Discussionmentioning

confidence: 70%

Cheatham-Platinum stent for native and recurrent aortic coarctation in children and adults: immediate and early follow-up results

Erdem¹,

Akdeni̇z²,

Sarıtaş³

et al. 2011

Anadolu Kardiyol Derg

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“…18,19 Although rare, aortic rupture and dissection have been reported during stenting for adult CoA. 14,20,21 For this reason, covered aortic stents should always be available when by guest on May 11, 2018 http://circinterventions.ahajournals.org/ Downloaded from Uncovered Self-Expandable Stent CoA treating these patients, 22,23 as reported in our experience. Literature data indicate that an aggressive balloon angioplasty of the native aorta and repeated dilatations of the stent contribute to the overall risk of iatrogenic aortic wall damage.…”

Section: Procedural Safetymentioning

confidence: 69%

Percutaneous Treatment of Adult Isthmic Aortic Coarctation

Kische

D’Ancona

Stoeckicht

et al. 2015

Circ: Cardiovascular Interventions

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A CT angiography was performed to assess aortic, neck, and peripheral access vessels anatomy. In the majority of cases, diagnostics were supplemented by MRI of intracranial vessels to rule-out cerebral Background-To present perioperative and long-term results of percutaneous treatment of adult isthmic coarctation of the aorta by means of a self-expandable closed-web uncovered nitinol stent (Sinus-XL, Optimed, Esslingen, Germany). Methods and Results-Preoperative, perioperative, and long-term clinical and computed tomographic angiography data were collected and analyzed prospectively. A total of 52 consecutive patients were treated with the Sinus-XL stent.Mean age was 36.6 (21-67) years, peak invasive trans-coarctation of the aorta gradient was 54.7±9.9 mm Hg, and upper body hypertension unresponsive to medical treatment was present in all patients. Mean stent diameter and length were 24.2 mm (22-28 mm) and 70.4 mm (40-80 mm), respectively. Eight patients (15.4%) required coarctation of the aorta predilatation. All patients underwent poststent dilatation with a noncompliant balloon. Postoperative peak gradient (3.3±2.5 mm Hg) was reduced significantly (P<0.001) and minimal aortic diameter was increased significantly (4.6±1.9 versus 18.6±2.5 mm; P<0.001). All patients were discharged home (mean hospitalization, 3.5 days). At follow-up (47.6 months; 12-84), 1 (1.9%) noncardiovascular mortality was reported. Aortic computed tomography confirmed the absence of stent collapse and secondary migration and documented stability in aortic diameter (18.3±2.7 mm). Thirty patients (57.7%) were completely weaned-off antihypertensive medications and their use dropped from 2.6 to 0.9 drugs/patient (P<0.001). Ankle-brachial pressure index increased from 0.75 to 0.98 (P<0.001). Conclusions-Adult coarctation of the aorta treatment by means of a self-expandable uncovered stent is safe and durable. The peculiar stent design maintains adequate localized radial strength over time with minimal trauma on the adjacent aortic wall and negligible device-related complications. Blood pressure control optimization is immediate and persistent even at longterm follow-up. (Circ Cardiovasc Interv. 2015;8:e001799.

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“…10 Some complications including balloon rupture, stent migration and aneurysm formation caused by stent implantation have been reported and those may be related to using over enlarged balloons. 8,11,12 The current data suggest that the diameter of DAo may not always be a proper gauge to determine the size for catheter enlargement. Nielsen et al reported that the narrowest aortic CSA indexed to the BSA using magnetic resonance imaging is a more reliable marker for detecting significant CoA (pressure gradients >20 mmHg).…”

Section: Circulation Journal Vol72 December 2008mentioning

confidence: 81%

Morphometric Analysis of Aortic Coarctation Determination of the Target Vessel Diameter Required to Relieve the Pressure Gradient

Takeda

Murakami

2008

Circ J

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Aortic dissection after stent dilatation for coarctation of the aorta: A case report and literature review

Abstract: A case of stenting for native coarctation is described in a 65-year-old female with a fatal dissection after implantation. The histology of the aorta in coarctation and in the elderly is described. The experience of stenting in older patients is reviewed and discussed.

Cited by 80 publications

References 23 publications

Cheatham-Platinum stent for native and recurrent aortic coarctation in children and adults: immediate and early follow-up results

Cheatham-Platinum stent for native and recurrent aortic coarctation in children and adults: immediate and early follow-up results

Percutaneous Treatment of Adult Isthmic Aortic Coarctation

Morphometric Analysis of Aortic Coarctation Determination of the Target Vessel Diameter Required to Relieve the Pressure Gradient

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