title: Endovascular stent placement is an acceptable alternative to reoperation in selected infants with residual or recurrent aortic arch obstruction.
abstract: OBJECTIVE
  To describe endovascular stent placement in infants as a technically feasible option in circumstances where surgery is considered less favorable.
  
  
  BACKGROUND
  Endovascular stent placement has become established as a first line therapy for native coarctation of the aorta or recoarctation in older children where stents capable of expansion to adult size can be placed safely. Surgery remains the therapy of choice in infants and young children. The management of aortic arch obstruction in infants is, however, frequently complicated by complex anatomy or clinical condition that may make surgery or further surgery an unattractive option. There is little reported data and the implications thereof of transcatheter stent placement in aortic arch obstruction in infants.
  
  
  METHODS
  Between August 2004 and November 2009, 11 patients had aortic arch obstruction treated with endovascular stent placement. The median age and weight at first stent placement was 46 days (range 3-399 days) and 4 kg (range 1.4-8 kg), respectively. In 10 patients, surgical intervention preceded transcatheter stent placement. Four had complex aortic arch obstruction and seven had recoarctation.
  
  
  RESULTS
  Reduction in peak systolic gradient to <10 mm Hg was achieved in seven of 10 patients with an improvement in aortic artery diameter to >90% of adjacent aorta in all. The diameter of the arch obstruction increased from a median of 1.60 to 4.90 mm (P = 0.001) and the peak systolic gradient from 45 mm Hg to 8 mm Hg (P < 0.0001). Adverse events occurred in two patients one who required further surgical revision and a second who required placement of a second stent. The median follow up was 3.60 years (range 0.4-5.5 years) with two patients having died at 1.34 and 1.42 years poststent placement. Of the nine patients alive, six have since undergone further angioplasty at a median time interval of 0.77 years (range 0.17-2.76 years). Long-term complications occurred in none.
  
  
  CONCLUSIONS
  Endovascular stent placement in infants is technically feasible with good results achievable even in small babies. It should be considered as a therapeutic option in complex cases when surgical alternatives are less favorable.
authors.affiliation: Department of Paediatric Cardiology and Cardiothoracic Surgery, John Radcliffe Hospital, Oxford, United Kingdom.
authors.forename: Jamie
authors.initials: J
authors.lastname: Bentham
authors.forename: Naveen
authors.initials: N
authors.lastname: Shettihalli
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Orchard
authors.forename: Stephen
authors.initials: S
authors.lastname: Westaby
authors.forename: Neil
authors.initials: N
authors.lastname: Wilson
mesh_terms: D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D001017:Aortic Coarctation / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D001027:Aortography; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D004739:England; D006439:Hemodynamics; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome