Covered stents in the management of coarctation of the aorta in the adult: initial results and 1-year angiographic and hemodynamic follow-up.
BACKGROUND
The purpose of this study was to determine the safety and efficacy of the Cheatham Platinum covered stent in adults with coarctation of the aorta.


METHODS
Adults with native coarctations (n=14); previous coarctation surgery (n=4), stenting (n=1) or both surgery and endovascular therapy (n=3) underwent percutaneous intervention with a covered stent. Indications for stenting in those with previous intervention were recurrent coarctation (n=4), aneurysm formation at the site of previous intervention (n=2) or both recurrent coarctation and aneurysm formation (n=2).


RESULTS
Twenty-three covered stents were placed in 22 patients (mean age 39+/-14 years, n=11 males). Successful device deployment was achieved in all patients, although one patient required a second covered stent for aortic wall rupture. Peak systolic gradient across the coarctation site decreased from 29+/-17 to 3+/-5 mm Hg (p<0.001) immediately following implant and this was maintained (6+/-9 mm Hg, p=0.001) at invasive assessment, 12 months after the initial procedure. Right arm systolic blood pressure significantly declined (p=0.02), as did the number of antihypertensive medications per patient (p=0.03). At angiographic follow-up, post-stenotic dilatation of the aorta decreased from 32+/-8 mm to 30+/-8 mm (p=0.001), however, no stent recoil was observed.


CONCLUSIONS
Covered stents are safe, durable and efficacious in the management of coarctation of the aorta. Angiography and hemodynamic assessment is an effective method of screening for recurrent coarctation, and arch and vascular complications after stenting in adults.
Tanous
David
D
Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network/Toronto General Hospital, Toronto, Ontario, Canada.
Collins
Nicholas
N
Dehghani
Payam
P
Benson
Lee N
LN
Horlick
Eric M
EM
D000328:Adult; D000368:Aged; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D001014:Aortic Aneurysm / Q000209:etiology; D001017:Aortic Coarctation / Q000628:therapy*; D020099:Coated Materials, Biocompatible; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010984:Platinum; D011475:Prosthesis Failure; D012008:Recurrence; D012189:Retrospective Studies; D012449:Safety; D015607:Stents / Q000009:adverse effects; D016896:Treatment Outcome
D020099:Coated Materials, Biocompatible; D010984:Platinum