title: First-in-man use of a tapered endovascular stent graft for treatment of aneurysm after coarctation repair.
abstract: OBJECTIVE
  Endovascular stenting of aneurysms late after surgical repair of coarctation may have to deal with marked changes in aortic diameter proximal and distal to the aneurysm. We report our first-in-man successful use of a custom-made tapered (variable diameter) covered stent.
  
  
  METHODS
  The aneurysm was 42 mm in diameter with a length of 40 mm. On MRI, the aorta measured 19.6 mm proximal and 13.3 mm distal to the aneurysm. The aim was to oversize the stent by 10-20%. A covered Cheatham-platinum stent was designed so that cranial portion of the stent would expand to 22 mm and the caudal portion to 15 mm with a length of 8.5 cm when fully inflated. The stent was mounted on a balloon-in-balloon delivery system and was delivered through an 18 F femoral arterial sheath. Rapid-pacing technique was used for deployment.
  
  
  RESULTS
  The stent was successfully deployed without complications. After deployment, the stent diameter measured 21.2 mm cranially and 15.6 mm caudally. A mild distal endoleak due to inadequate fixation of the stent graft was resolved by post dilation expanding the stent diameter to 22.1 mm and 15.9 mm, respectively. The femoral access site was closed using two percutaneous closure devices and the patient discharged the day after the procedure. Follow-up CT-angiography showed continued successful exclusion of the aneurysm.
  
  
  CONCLUSIONS
  A new custom-made balloon expandable covered stent-design enabled successful treatment of an aortic aneurysm. This design may offer greater potential for more favorable initial angiographic results and potentially long-term outcomes due to superior apposition to the aortic wall.
authors.affiliation: Division of Cardiology, Department of Medicine, St Paul's Hospital, Vancouver, British Columbia, Canada.
authors.forename: Fabian
authors.initials: F
authors.lastname: Nietlispach
authors.forename: Jonathon
authors.initials: J
authors.lastname: Leipsic
authors.forename: Namal
authors.initials: N
authors.lastname: Wijesinghe
authors.forename: John G
authors.initials: JG
authors.lastname: Webb
authors.forename: Ronald G
authors.initials: RG
authors.lastname: Carere
mesh_terms: D000328:Adult; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation*; D001014:Aortic Aneurysm / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D001017:Aortic Coarctation / Q000601:surgery*; D001027:Aortography; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D057867:Endoleak / Q000209:etiology; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D011474:Prosthesis Design; D015641:Radiography, Interventional; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome