Native aortic coarctation stenting in patients ≥ 46 years old

Abstract

IntroductionStent implantation is an effective therapy for aortic coarctation (CoA) in adolescents and adults.AimTo present a unique group of patients with native coarctation of the aorta older than or equal to 46 years treated with bare metal or covered stents.Material and methodsSince 2002 we have performed stent implantations by applying bare metal stents or covered stents using femoral access in 24 patients aged 46 and older.ResultsWe used the Mullins technique in all cases, implanting different stents: Palmaz, Cheatham-Platinum (CP), covered CP or Andrastents XL/XXL. Twenty-one procedures were elective and 3 were urgent. Eighteen bare metal stents (2 stents in one patient) and 7 covered stents were used. All procedures were effective (CoA gradient reduced < 20 mm Hg), despite 2 migrations of bare metal stents. Mean gradient was reduced from 50.6 ±15.3 to 6.8 ±6.5 mm Hg (p < 0.001) and mean lumen diameter of stenosed aorta increased from 5.5 ±2.5 to 14.9 ±5.2 mm (p < 0.001). One special case is discussed – a 49-year-old man with end staged heart failure and severe CoA, who underwent a rescue procedure with a bare metal stent. One serious complication – stroke of the central nervous system – was observed in a 53-year-old woman during covered stent implantation (symptoms resolved during rehabilitation process).ConclusionsStent implantation of native coarctation of the aorta is also a safe procedure in the eldest patients and is associated with persistent relief of aortic obstruction.

Refractory hypertension and the lower limbs ischaemia as an aortic coarctation symptom

“…It is less invasive and demonstrates lower complication rates. Stenting also carries a lower risk of re-coarctation and aneurysm formation [18][19][20]. Patients after aortic coarctation treatment require close monitoring over their lifetime for complications such as recoarctation, aortic aneurysm, persistent hypertension and changes in any associated cardiac defects.…”