Endovascular aortic coarctation stenting in adolescents and adults: angiographic and hemodynamic outcomes.
OBJECTIVE
To assess the procedural, clinical, angiographic, and hemodynamic outcomes, including ambulatory blood pressure monitoring at 1 year in adolescent and adult patients undergoing primary stenting for treatment of aortic coarctation.


BACKGROUND
Stenting is widely used for treatment of aortic coarctation. Data regarding efficacy of this treatment for control of hypertension at 1 year is scant, with only one reported series of planned angiographic follow up. The impact of newer type stents for this procedure is also unknown.


METHODS
Thirty-seven patients undergoing stenting for aortic coarctation, over a 3-year period in a tertiary centre were studied as part of an observational protocol.


RESULTS
Peak gradient across the coarctation fell from 28.3 +/- 15.1 to 3.7 +/- 4.1 post procedure and was 11.9 +/- 8.9 mmHg (P < 0.05 compared to baseline) at 1 year. There was one major complication (2.7%), with no deaths. Small aneurysms were seen in three patients (13%) on follow up angiography at 1 year. Right arm systolic blood pressures fell from 155 +/- 19 to 132 +/- 22 (P < 0.05) at 6 weeks and was 132 +/- 16 mmHg (P < 0.05 compared to baseline) at 1 year. Ambulatory average systolic blood pressures fell from 142 +/- 14 to 133 +/- 15 at 6 weeks (P < 0.05) and to 125 +/- 12 mmHg (P < 0.05 compared to baseline) at 1 year. No significant differences were seen in procedural outcomes between patients receiving Palmaz and CPNumed stents.


CONCLUSIONS
Primary stenting of aortic coarctation in adolescents and adults results in excellent clinical and angiographic outcomes and sustained hemodynamic benefits at 1 year as evidenced by significant reduction in systolic blood pressure and gradients. Close follow up is required to monitor aneurysm formation.
Mahadevan
Vaikom S
VS
Adult Congenital Heart Unit, Royal Brompton Hospital, London, SW3 6NP, United Kingdom. viakom.mahadevan@cmmc.nhs.uk
Vondermuhll
Isabelle F
IF
Mullen
Michael J
MJ
D000293:Adolescent; D000328:Adult; D001017:Aortic Coarctation / Q000000981:diagnostic imaging / Q000628:therapy*; D018660:Blood Pressure Monitoring, Ambulatory; D006328:Cardiac Catheterization; D017023:Coronary Angiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents; D016896:Treatment Outcome