Transcatheter therapy of long extreme subatretic aortic coarctations with covered stents

Ewert, Peter; Abdul‐Khaliq, Hashim; Peters, Bjoern; Nagdyman, Nicole; Schubert, Stephan; Lange, Peter

doi:10.1002/ccd.20119

Cited by 49 publications

(55 citation statements)

References 11 publications

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“…PRE, before; POST, after intervention. Experience in the use of covered stents to manage aortic coarctation is limited [67][68][69][70][71][72][73][74]. Different types of stents to treat aortic coarctation have been used and include Jostent grafts (Jomed International, Helsingborg, Sweden), C-P stents (NuMed Inc, Hopkinton, NY), AneuRx (Medtronic, Watford, UK), Advanta V12 (Atrium Medical, Hudson, NH) and others.…”

Section: Intermediate Follow Upmentioning

confidence: 99%

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Coarctation of Aorta-Management Options and Decision Making

Doshi¹

2012

Pediat Therapeut

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Coarctation of the Aorta (CoA) is a congenital cardiac anomaly consisting of a constricted aortic segment with a prevalence of 5 to 8% of all Congenital Heart Defects (CHD). The classic CoA is located in the thoracic aorta distal to the origin of the left subclavian artery, at about the level of the ductal structure. Significant hypertension and/or congestive heart failure are indications of intervention. If hypertension (rather that heart failure) is the clinical problem, it is better to relieve the aortic obstruction promptly rather that attempting to "treat" hypertension with antihypertensive medications. Surgical relief of the aortic obstruction and catheter interventional techniques (balloon angioplasty and stents) are available alternatives. Since the introduction of surgical correction by Crafoord and Nylin and Gross and Hufnagel in early 1940s, surgical therapy has been the treatment of choice for aortic coarctation. Gruntzig's technique of balloon angioplasty was adopted by Singer and Sperling and their associates to enlarge coarcted aortic segments in post-surgical recoarctation and native coarctation, respectively in early 1980s. This is followed by the application of the technique by other cardiologists to treat native CoA. The procedure consists of inserting a balloon angioplasty catheter across the site of coarctation and inflating the balloon with diluted contrast material. Both immediate and followup results are reasonably good. Residual and recurrent obstructions following surgery and prior balloon angioplasty are also amenable for balloon angioplasty. Despite reasonably good short-term and long-term results of balloon angioplasty, some problems remain and include restenosis, probability of aortic rupture, formation of aneurysms and inability to effectively treat long-segment tubular narrowing. Because of these and other reasons, endovascular stenting of aortic coarctation has gained acceptance over the last decade. The balloon catheter, with the stent mounted on it, is advanced over a stiff guide wire and positioned across the coarctation segment and the balloon inflated, thus implanting the stent. Most cardiologists use stents in adolescents and adults and restrict their use in younger children because of issues related to growth. Stent therapy appears to be an attractive method for treatment of native or recurrent coarctation, aneurysm formation following prior surgical or balloon intervention and for long segment hypoplasia. Role of covered stents to manage aortic coarctation is limited and are used when the assessed risk for development of aneurysm or dissection is high. A comparison of all available treatment modalities was made and while it is difficult to make a definitive statement, the overall data seem to indicate that transcatheter methods may be better than surgery. Selection of the method of therapy is largely based on the age at presentation and anatomy of the coarcted segment and surrounding structures; surgery for infants and long segment coarctations, balloon angioplast...

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Section: Intermediate Follow Upmentioning

confidence: 99%

“…When the assessed risk for development of aneurysm or dissection is high, a covered stent should be used. The results of the limited use of covered stents appear to be good [67][68][69][70][71][72][73][74][75][76][77]. Some of the stents can be expanded to only an 18-mm diameter.…”

Section: Intermediate Follow Upmentioning

confidence: 99%

Coarctation of Aorta-Management Options and Decision Making

Doshi¹

2012

Pediat Therapeut

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“…Covered stents have been used successfully in the management of aortic coarctation and a number of reports document this experience [117][118][119][120][121][122][123][124][125][126][127][128][129][130][131][132][133][134][135][136] A variety of covered stents have been utilized and these include Jostent grafts (Jomed International, Helsingborg, Sweden), Cheatham-Platinum stents (NuMed Inc, Hopkinton, NY), AneuRx (Medtronic, Watford, UK), Advanta V12 (Atrium Medical, Hudson, NH) and others. While these stents are available outside the United States, they are not approved by the US Food and Drug Administration (FDA) for clinical use.…”

Section: Covered Stentsmentioning

confidence: 99%

Transcatheter Stent Therapy in Children: An Update

Sahu

Rao²

2012

Pediat Therapeut

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To address elastic recoil of vessel wall and intimal dissection that can follow balloon angioplasty, stents have been designed and these appear to produce more effective relief of obstruction. Of the two types of stents, namely, balloon expandable and self expandable, balloon expandable stents are most commonly used in children. The usefulness of stents in the management of vascular obstructive lesions not amenable to balloon angioplasty is well established and has been successfully used to treat branch pulmonary artery stenosis, coarctation of the aorta, stenotic right ventricular outflow tract conduits, obstructive lesions of the systemic and pulmonary veins and others. The techniques of implantation, indications, immediate and follow-up results and complications were reviewed. The stents have also been effectively used in keeping open naturally occurring or artificially created inter-circulatory connections and as adjuncts in hybrid procedures, but these have not been discussed in this review. Future directions include investigative work on biodegradable stents and growth stents to address issues related to increase in vessel size in infants and children, use of drug eluding stents to prevent neo-intimal proliferation to avoid pulmonary vein restenosis and refinement of stent technology in hybrid procedures such as neonatal palliation of hypoplastic left heart syndrome and transcatheter completion of Fontan procedure. The feasibility, safety and effectiveness stents in the pediatric population are demonstrated, although scrutiny of results of larger experience with longer follow-up is important.

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“…Eleven coarctations were treated with 12 covered stents (fig 1) because of the severity of the lesion (10), to the presence of an aneurysm (one) (fig 3), or to a stent fracture (1). 26 In pulmonary arteries, three stents were placed in native lesions During the follow up period of 12 months (1-30 months) two patients died of unrelated causes. Twenty four patients underwent computed tomography or magnetic resonance imaging 4-12 weeks after stent implantation.…”

Section: Coarctations and Pulmonary Arteriesmentioning

confidence: 99%

The CP stent--short, long, covered--for the treatment of aortic coarctation, stenosis of pulmonary arteries and caval veins, and Fontan anastomosis in children and adults: an evaluation of 60 stents in 53 patients

Ewert

Schubert²,

Peters³

et al. 2005

Heart

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Objective: To evaluate the feasibility and usefulness of the Cheatham platinum (CP) stent in a broad spectrum of lesions. Methods: Retrospective analysis of 60 implanted CP stents (11-80 mm lengths, 12 covered) between September 2001 and March 2004. Patients: 53 patients aged 2.5-68 years (median 17 years). Body weight ranged from 12-95 kg (median 52 kg). Thirty six patients had aortic (re)coarctation; seven of them had functionally interrupted aortic arches. Thirteen patients had pulmonary artery stenosis and four had stenosis of caval veins or conduits in a total cavopulmonary connection (TCPC). Results: Arterial pressure gradients dropped from 33 mm Hg (range 20-80 mm Hg) to 5 mm Hg (range 0-10 mm Hg) and pressure gradients in TCPC or caval veins dropped from 4 mm Hg (range 4-20 mm Hg) to 0 mm Hg (range 0-3 mm Hg). All stents were placed in the target lesion without complications. Three stent fractures without clinical instability were noted. Conclusions: The CP stent is suitable for the treatment of vessel stenosis in congenital heart diseases from childhood to adulthood. Whether these good results will be stable in the long term needs to be investigated.

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Transcatheter therapy of long extreme subatretic aortic coarctations with covered stents

Cited by 49 publications

References 11 publications

Coarctation of Aorta-Management Options and Decision Making

Coarctation of Aorta-Management Options and Decision Making

Transcatheter Stent Therapy in Children: An Update

The CP stent--short, long, covered--for the treatment of aortic coarctation, stenosis of pulmonary arteries and caval veins, and Fontan anastomosis in children and adults: an evaluation of 60 stents in 53 patients

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