Endovascular stents for coarctation of the aorta: initial results and intermediate-term follow-up.
OBJECTIVE
The aim of this study was to evaluate the use of endovascular stents in native and recurrent coarctation of the aorta (CoA).


BACKGROUND
Stents have been used successfully in various locations. Their use in CoA can be an alternative to surgery or balloon angioplasty (BA).


METHODS
Thirty-four patients with CoA (13 native and 21 re-coarctation after surgery or BA) with a mean age of 16 +/- 8 years (range 4 to 36 years) underwent attempted stent implantation between 1993 and 1999. Successful outcome was defined as peak systolic pressure gradient after stent implantation < 20 mm Hg.


RESULTS
Stents were implanted in 33/34 patients, and successful outcome occurred in 32/33 patients. Peak systolic pressure gradient decreased from 32 +/- 12 mm Hg to 4 +/- 11 mm Hg (p < 0.001). Coarctation site to descending aorta diameter ratio increased from 0.46 +/- 0.16 to 0.92 +/- 0.16 (p < 0.001). Two patients underwent successful stent re-dilation 16 and 21 months after initial implantation. Six patients (18%) developed complications, including two patients who underwent surgery. Follow-up for 29 +/- 17 months (range: 5 to 81 months) demonstrated no evidence of re-coarctation, aneurysm formation, stent displacement or fracture. Systolic blood pressure (SBP) decreased from 136 +/- 21 mm Hg before stent placement to 122 +/- 19 mm Hg at follow-up (p = 0.002). The SBP gradient decreased from 39 +/- 18 mm Hg to 4 +/- 6 mm Hg, and peak Doppler gradient decreased from 51 +/- 26 mm Hg to 13 +/- 11 mm Hg at follow-up (p < 0.001).


CONCLUSIONS
Intravascular stent placement for native and recurrent CoA has excellent results in the short and intermediate terms. Long-term outcome remains to be evaluated.
Hamdan
M A
MA
Section of Pediatric Cardiology, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA.
Maheshwari
S
S
Fahey
J T
JT
Hellenbrand
W E
WE
D000293:Adolescent; D000328:Adult; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D001017:Aortic Coarctation / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D001794:Blood Pressure; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D017023:Coronary Angiography; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016014:Linear Models; D008279:Magnetic Resonance Imaging; D008297:Male; D012008:Recurrence; D012086:Reoperation; D015607:Stents / Q000009:adverse effects / Q000592:standards*; D013599:Systole; D016896:Treatment Outcome