Use of Covered Stents in the Management of Coarctation of the Aorta

Abstract

We report our experience with the use of covered stents for the management of coarctation of the aorta. From December 2001 to March 2004, nine patients (seven males; median age, 31 years; mean weight, 65 +/- 15 kg) underwent implantation. Indications included critical or atretic native coarctation (n = 4), patients >50 years of age (n = 2), associated patent ductus arteriosus (n = 1) or adjacent aneurysm (n = 1), and the presence of a circumferential fracture within a previously implanted stent (n = 1). The covered balloon-expandable Cheatham-Platinum stent and the self-expandable stent graft Braile were employed. Adequate implantation was observed in all patients. Gradients were reduced from 54 +/- 14 to 3 +/- 8 mmHg and the coarctation site increased from 2.4 +/- 2.9 to 15.9 +/- 4.3 mm. The patent ductus arteriosus was immediately closed and the aneurysm excluded. Two patients >35 years with aneurysmal ascending aorta and metallic aortic prosthesis had aneurysm formation at follow-up, with one undergoing aneurysm exclusion using a Braile stent. Although covered stents are useful in the management of selected patients with coarctation, aneurysm formation may still occur in patients with markers of aortic wall weakness. Refinements in the deployment technique and/or the stent design are needed to eliminate this risk.

Stenting in Congenital Heart Disease

“…20- 22 Furthermore, for coarctation, covered stent implantation is becoming a common procedure. [23][24][25] In the present survey, we clarified that, even in Japan, the Genesis stent is gradually being introduced to real-life clinical practice. However, it is clearly off-label use and because of the limited specifications available in Japan, it has been used in strictly limited situations.…”

Transcatheter Stent Therapy in Children: An Update

“…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.…”

Aortic Coarctation Following Aortic Valve Replacement: Problem Solving with Multimodality Cardiac Imaging

“…For our patient, this diagnosis was missed prior to aortic valve replacement in his native country. Utilization of covered stents for percutaneous treatment of aortic coarctation, atretic coarctation, and even an interrupted aorta has been shown to be successful in both adult and pediatric populations [1][2][3][4]. As shown in our case, intervention can help confirm a diagnosis and offer definitive treatment if a diagnosis of aortic coarctation, atretic coarctation or interrupted aortic arch are difficult to distinguish.…”