Procedural results and acute complications in stenting native and recurrent coarctation of the aorta in patients over 4 years of age: a multi-institutional study.
BACKGROUND
We report a multi-institutional experience with intravascular stenting (IS) for treatment of coarctation of the aorta.


RESULTS
Data was collected retrospectively by review of medical records from 17 institutions. The data was broken down to prior to 2002 and after 2002 for further analysis. A total of 565 procedures were performed with a median age of 15 years (mean=18.1 years). Successful reduction in the post stent gradient (<20 mm Hg) or increase in post stent coarctation to descending aorta (DAo) ratio of >0.8 was achieved in 97.9% of procedures. There was significant improvement (P<0.01) in pre versus post stent coarctation dimensions (7.4 mm+/-3.0 mm vs. 14.3+/-3.2 mm), systolic gradient (31.6 mm Hg+/-16.0 mm Hg vs. 2.7 mm Hg+/-4.2 mm Hg) and ratio of the coarctation segment to the DAo (0.43+/-0.17 vs. 0.85+/-0.15). Acute complications were encountered in 81/565 (14.3%) procedures. There were two procedure related deaths. Aortic wall complications included: aneurysm formation (n=6), intimal tears (n=8), and dissections (n=9). The risk of aortic dissection increased significantly in patients over the age of 40 years. Technical complications included stent migration (n=28), and balloon rupture (n=13). Peripheral vascular complications included cerebral vascular accidents (CVA) (n=4), peripheral emboli (n=1), and significant access arterial injury (n=13). Older age was significantly associated with occurrence of CVAs. A significant decrease in the technical complication rate from 16.3% to 6.1% (P<0.001) was observed in procedures performed after January 2002.


CONCLUSIONS
Stent placement for coarctation of aorta is an effective treatment option, though it remains a technically challenging procedure. Technical and aortic complications have decreased over the past 3 years due to, in part, improvement in balloon and stent design. Improvement in our ability to assess aortic wall compliance is essential prior to placement of ISs in older patients with coarctation of the aorta.
Forbes
Thomas J
TJ
Division of Cardiology, Children's Hospital of Michigan, and Wayne State University, Detroit, Michigan 48201, USA. tforbes@dmc.org
Garekar
Swati
S
Amin
Zahid
Z
Zahn
Evan M
EM
Nykanen
David
D
Moore
Phillip
P
Qureshi
Shakeel A
SA
Cheatham
John P
JP
Ebeid
Makram R
MR
Hijazi
Ziyad M
ZM
Sandhu
Satinder
S
Hagler
Donald J
DJ
Sievert
Horst
H
Fagan
Thomas E
TE
Ringewald
Jeremy
J
Du
Wei
W
Tang
Liwen
L
Wax
David F
DF
Rhodes
John
J
Johnston
Troy A
TA
Jones
Thomas K
TK
Turner
Daniel R
DR
Pedra
Carlos A C
CA
Hellenbrand
William E
WE
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D000800:Angioplasty, Balloon / Q000009:adverse effects* / Q000295:instrumentation / Q000401:mortality; D001017:Aortic Coarctation / Q000000981:diagnostic imaging / Q000628:therapy*; D001018:Aortic Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality; D001027:Aortography; D001938:Brazil / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D004739:England / Q000453:epidemiology; D004868:Equipment Failure; D005548:Foreign-Body Migration / Q000000981:diagnostic imaging / Q000209:etiology*; D006801:Humans; D016015:Logistic Models; D016017:Odds Ratio; D016491:Peripheral Vascular Diseases / Q000000981:diagnostic imaging / Q000209:etiology*; D011474:Prosthesis Design; D012008:Recurrence; D012107:Research Design; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology