Balloon-expandable stent treatment of experimental coarctation of the aorta: early hemodynamic and pathological evaluation.
The present study was intended to evaluate the acute and short-term hemodynamic, angiographic, and pathological response to balloon-expandable stent treatment of experimental coarctation of the aorta.  A discrete thoracic coarctation was surgically created in six mongrel dogs (two adults, four puppies).  Two months postoperatively all six dogs (8.9-30 kg) underwent left heart catheterization and coarctation stenting performed through a femoral artery cutdown.  A Palmaz PS-30 stent was advanced to the coarctation through a 10 French sheath, and expanded with an angioplasty balloon chosen to equal the diameter of the proximal aorta (9-12 mm).  Stent implantation was successful in each dog.  The systolic pressure gradient decreased from 26.3 +/- 9.1 mmHg (mean +/- SE) to 0.5 +/- 0.5 mmHg (P = 0.04), and the coarctation diameter improved from 50 +/- 6% to 82 +/- 6% of the diameter of the proximal descending aorta (P less than 0.01).  Follow-up catheterization 4-7 weeks after stenting documented no stent migration, early restenosis, thrombosis, obstruction of arterial side branches, or aneurysm formation.  Pathological evaluation of the explanted segments of stented aorta documented that by 6-7 weeks the stents are covered by a neointima composed of intimal proliferation and fibrosis with an endothelial cell surface.  These data suggest that balloon-expandable stainless steel stents provide excellent acute and short-term relief of coarctation in this experimental model. Larger and longer-term studies are needed to better assess the incidence of restenosis or aneurysm formation following stenting of coarctation of the aorta.
Beekman
R H
RH
Division of Pediatric Cardiology, Department of Pediatrics, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor.
Muller
D W
DW
Reynolds
P I
PI
Moorehead
C
C
Heidelberger
K
K
Lupinetti
F M
FM
D000792:Angiography; D000818:Animals; D001014:Aortic Aneurysm; D001017:Aortic Coarctation / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006328:Cardiac Catheterization / Q000379:methods; D004285:Dogs; D005069:Evaluation Studies as Topic; D006439:Hemodynamics; D012008:Recurrence; D013193:Stainless Steel; D015607:Stents; D013927:Thrombosis