Intermediate follow-up following intravascular stenting for treatment of coarctation of the aorta.
BACKGROUND
We report a multiinstitutional study on intermediate-term outcome of intravascular stenting for treatment of coarctation of the aorta using integrated arch imaging (IAI) techniques.


RESULTS
Medical records of 578 patients from 17 institutions were reviewed. A total of 588 procedures were performed between May 1989 and Aug 2005. About 27% (160/588) procedures were followed up by further IAI of their aorta (MRI/CT/repeat cardiac catheterization) after initial stent procedures. Abnormal imaging studies included: the presence of dissection or aneurysm formation, stent fracture, or the presence of reobstruction within the stent (instent restenosis or significant intimal build-up within the stent). Forty-one abnormal imaging studies were reported in the intermediate follow-up at median 12 months (0.5-92 months). Smaller postintervention of the aorta (CoA) diameter and an increased persistent systolic pressure gradient were associated with encountering abnormal follow-up imaging studies. Aortic wall abnormalities included dissections (n = 5) and aneurysm (n = 13). The risk of encountering aortic wall abnormalities increased with larger percent increase in CoA diameter poststent implant, increasing balloon/coarc ratio, and performing prestent angioplasty. Stent restenosis was observed in 5/6 parts encountering stent fracture and neointimal buildup (n = 16). Small CoA diameter poststent implant and increased poststent residual pressure gradient increased the likelihood of encountering instent restenosis at intermediate follow-up.


CONCLUSIONS
Abnormalities were observed at intermediate follow-up following IS placement for treatment of native and recurrent coarctation of the aorta. Not exceeding a balloon:coarctation ratio of 3.5 and avoidance of prestent angioplasty decreased the likelihood of encountering an abnormal follow-up imaging study in patients undergoing intravascular stent placement for the treatment of coarctation of the aorta. We recommend IAI for all patients undergoing IS placement for treatment of CoA.
Forbes
Thomas J
TJ
Children's Hospital of Michigan, Wayne State University, Detroit, Michigan, USA. tforbes@dmc.org
Moore
Phillip
P
Pedra
Carlos A C
CA
Zahn
Evan M
EM
Nykanen
David
D
Amin
Zahid
Z
Garekar
Swati
S
Teitel
David
D
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
Ringwald
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
Pass
Robert
R
Torres
Alejandro
A
Hellenbrand
William E
WE
D000293:Adolescent; D000328:Adult; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation*; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000473:pathology; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology; D001017:Aortic Coarctation / Q000000981:diagnostic imaging / Q000473:pathology / Q000628:therapy*; D001027:Aortography / Q000379:methods*; D001938:Brazil; D006328:Cardiac Catheterization; D002648:Child; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology; D005060:Europe; D005500:Follow-Up Studies; D006801:Humans; D018810:Magnetic Resonance Angiography; D017410:Practice Guidelines as Topic; D011475:Prosthesis Failure; D012107:Research Design; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014481:United States