Early and Midterm Results Following Interventional Coarctoplasty: Evaluation of Variables that Can Affect the Results

Abstract

Background and ObjectivesStent coarctoplasty has been approved as the treatment of choice for adult patients with coarctation of the aorta. We have evaluated the early and midterm clinical and procedural results after interventional coarctoplasty. Also, variables that can affect these results were evaluated.Subjects and MethodsGathering clinical, angiographic and procedural data, we evaluated the pre-specified outcomes, including procedural success, complications, the incidence of hypertension after coarctoplasty etc., after the procedure. The effect of pre-specified variables including aortic arch shape, coarctation type and etc. on the procedural result was evaluated.ResultsBetween February 2005 through March 2014, 133 stent coarctoplasty procedures were performed. Median age was 23.5 years old (interquartile range [IQR]:19-28), and 105 (71.9%) were male. Nearly all of the patients were undergone stent coarctoplasty, mostly with cheatham platinum (CP) stents. There was no association between aortic arch morphology and acute procedural complications. Balloon length more than 40 mm (p=0.028), aorta diameter at the site of Coarctation larger than 2.35 mm (p=0.008) was associated with higher rate of restenosis during follow-up. Comparison between the prevalence of hypertension (HTN) before and after coarctoplasty showed a significant reduction in the prevalence of HTN (117 [91.4%] vs. 95 [74.2%] p<0.001).ConclusionStent coarctoplasty is a low-risk procedure with favorable early and delayed outcomes. Most mortality is related to the patient's comorbid conditions and not to the procedure.

Late open conversion after endovascular treatment for the coarctation of aorta in adult due to restenosis with thrombus

“…9 Covered stents, especially balloon-expandable stents, are recommended considering the stronger radial force compared with self-expandable covered stents. 11,15 Balloon-expandable stents were not available owing to insurance restraints in Japan. In the present patient, CT had shown thrombus formation in the stenosed lesion.…”

“…The search terms included "adult coarctation of aorta" or "adult aortic coarctation" or "adult CoA" and "endovascular" or "TEVAR" or "transcatheter." Our search identified 27 eligible studies from 528 records, including 2 randomized controlled studies 11,21 and 25 observational studies, 3,7,15,17,[22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] with 2022 patients enrolled. The patient characteristics and outcomes are summarized in the Table.…”

Progress toward Approval of Stents in Coarctation of the Aorta

“…Bassri et al 9) committed favorable acute and delayed outcomes following transcatheter intervention with a stent for the correction of CoA in adult patients. These authors used mainly a bare CP stent, but a covered CP stent was used primarily for interruption of the aortic arch and for rescue immediately after aortic wall damage.…”