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

Abstract

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...

Native aortic coarctation stenting in adults and adolescents: early and mid-term results of an adult interventional cardiology team

“…This is the second largest series of CoA stenting in adults in our coun- Fig. 2 A- [12][13][14]. Our patient group consisted of adult patients different from the studies of Erdem and Baykan, both of which presented experiences with CoA stenting in pediatric patients.…”

“…However, re-intervention rates are higher in PTA and stenting than surgery [2][3][4][5][6][7][8][9][10]. Treatment should be performed shortly after establishment of the diagnosis to avoid possible late complications such as congestive heart failure, death, and hypertension-related events [14][15][16][17][18][19]. Half of the patients with hypertension can discontinue, or reduce the dose of antihypertensive drugs after successful surgical or transcatheter treatment of CoA.…”

“…Indications for stenting in CoA include unfavorable anatomy for balloon angioplasty such as tubular coarctation, hypoplasia of the aortic isthmus, long aortic segment stenosis [14][15][16][17][18][19][20], unsuccessful opening by balloon angioplasty, restenosis following angioplasty, and dissection after angioplasty. However, the majority of adult cases are commonly treated by stenting as a first line therapy [14][15][16][17][18][19][20].…”

“…However, the majority of adult cases are commonly treated by stenting as a first line therapy [14][15][16][17][18][19][20]. Procedural success was defined as a decrease in the pressure gradient between the proximal and distal aorta to below 10 mm Hg [11][12][13][14][15][16][17][18][19][20].…”

Balloon Angioplasty of Subatretic Coarctation of the Aorta Using Progressive Larger Balloons

“…The chance of recurrence in children older than two years decrease [3] and stent implantation is not performed in children less than 20 kg. In older children or young adults the subatretic coarctation is in general treated with covered stent implantation [6] to avoid aortic wall injury or pseudoaneurysm formation. In our case the important dilatation of the ascending aorta suggested a possible disease of the aortic wall which increased the risk of aneurysm or aortic wall injury caused by balloon angioplasty [4].…”