title: Stenting vs. balloon angioplasty for discrete unoperated coarctation of the aorta in adolescents and adults.
abstract: More information is needed to clarify whether stenting is superior to balloon angioplasty (BA) for unoperated coarctation of the aorta (CoA). From September 1997, 21 consecutive adolescents and adults (24 +/- 11 years) with discrete CoA underwent stenting (G1). The results were compared to those achieved by BA performed in historical group of 15 patients (18 +/- 10 years; P = 0.103; G2). After the procedure, systolic gradient reduction was higher (99% +/- 2% vs. 87% +/- 17%; P = 0.015), residual gradients lower (0.4 +/- 1.4 vs. 5.9 +/- 7.9 mm Hg; P = 0.019), gain at the CoA site higher (333% +/- 172% vs. 190% +/- 104%; P = 0.007), and CoA diameter larger (16.9 +/- 2.9 vs. 12.9 +/- 3.2 mm; P < 0.001) in G1. Aortic wall abnormalities were found in eight patients in G2 (53%) and in one in G1 (7%; P < 0.001). There was no major complication. Repeat catheterization (n = 33) and/or MRI (n = 2) was performed at a median follow-up of 1.0 year for G1 and 1.5 for G2 (P = 0.005). Gradient reduction persisted in both groups, although higher late gradients were seen in G2 (median of 0 mm Hg for G1 vs. 3 for G2; P = 0.014). CoA diameter showed no late loss in G1 and a late gain in G2 with a trend to being larger in G1 (16.7 +/- 2.9 vs. 14.6 +/- 3.9 mm; P = 0.075). Two patients required late stenting due to aneurysm formation or stent fracture in G1. Aortic wall abnormalities did not progress and one patient required redilation in G2. Blood pressure was similar in both groups at follow-up (126 +/- 12/81 +/- 11 for G1 vs. 120 +/- 15/80 +/- 10 mm Hg for G2; P = 0.149 and 0.975, respectively). Although satisfactory and similar clinical outcomes were observed with both techniques, stenting was a better means to relieve the stenosis and minimize the risk of developing immediate aortic wall abnormalities.
authors.affiliation: Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil.
authors.forename: Carlos A C
authors.initials: CA
authors.lastname: Pedra
authors.forename: Valmir F
authors.initials: VF
authors.lastname: Fontes
authors.forename: Cesar A
authors.initials: CA
authors.lastname: Esteves
authors.forename: Carlo B
authors.initials: CB
authors.lastname: Pilla
authors.forename: Sérgio L N
authors.initials: SL
authors.lastname: Braga
authors.forename: Simone R F
authors.initials: SR
authors.lastname: Pedra
authors.forename: M Virginia T
authors.initials: MV
authors.lastname: Santana
authors.forename: M Aparecida P
authors.initials: MA
authors.lastname: Silva
authors.forename: Tarcisio
authors.initials: T
authors.lastname: Almeida
authors.forename: J Eduardo M R
authors.initials: JE
authors.lastname: Sousa
mesh_terms: D000293:Adolescent; D000328:Adult; D000792:Angiography; D000800:Angioplasty, Balloon / Q000379:methods*; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D001017:Aortic Coarctation / Q000000981:diagnostic imaging* / Q000628:therapy*; D006328:Cardiac Catheterization; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging / Q000628:therapy; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007902:Length of Stay; D008297:Male; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D015607:Stents; D016896:Treatment Outcome