Angioplasty or stenting in adult coarctation of the aorta? A retrospective single center analysis over a decade.
For over 11 years, endovascular treatment by angioplasty (PTA) alone or stenting of adult coarctation at a single center was evaluated. We retrospectively reviewed 28 consecutive patients (31 interventions), median age 25 years, treated between 1991 and 2002, 20 of whom had native coarctation. Thirteen patients had PTA alone (16 procedures) (10 "kissing balloon" angioplasty comprising 12 interventions, and 3 single balloon angioplasty comprising 4 interventions) and 15 patients were stented (15 procedures), including 6 secondary and 9 primary stents. There were no procedural or 30-day complications. For the whole group, the median follow-up was 6.6 years (range 1-10 years). In the PTA group, median follow-up was 9 years (range 3-10) and in the stenting group it was 3 years (range 1-5). There were 9 restenoses in the PTA group (6 after "kissing balloons" and 3 after single balloon) comprising 56% of the angioplasties (9/16 procedures). There was 1 restenosis in the stenting group diagnosed at computed tomography (CT). The patient was clinically well. For the whole group there were significant reductions in systolic blood pressure (BP) (p = 0.0003), diastolic BP (p = 0.004) and number of drugs per patient (p = 0.045) at latest follow-up post-treatment. Five patients discontinued therapy. Analysis of the groups revealed that the reduction of systolic and diastolic BP and number of drugs did not reach statistical significance in the PTA group but were significant in the stent group. The endovascular management of adult coarctation is safe. Stents may be more effective than PTA alone but longer-term follow-up of stents is required.
Macdonald
Sumaira
S
The Sheffield Vascular Institute, Northern General Hospital, Sheffield, UK. sumaira@primedia.co.uk
Thomas
Steven M
SM
Cleveland
Trevor J
TJ
Gaines
Peter A
PA
D000328:Adult; D000800:Angioplasty, Balloon; D001017:Aortic Coarctation / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors