Endovascular stenting for native coarctation in older children and adolescents using adult self-expanding (Nitinol) iliac stents.
BACKGROUND
The role of balloon-expandable stents for native coarctation has been proven in several small studies. Use of Nitinol-made self-expanding stents in such situations is reported in adults in only a few cases. For the last 5 years we used self expanding nitinol stents (primarily recommended for iliac angioplasty in adults in this condition in older children.


METHODS
There were 32 patients in total (24 males; mean age 10.2 +/- 1.43 years; youngest 6-years-old). Successful procedure is defined as reduction of gradient to less than 20 mmHg or increase in the ratio of the diameter of the coarctation area to the diameter of the descending aorta to at least 0.8. Bard luminexx vascular stents were used in all cases.


RESULTS
In 32 patients 32 stents were used with overall success rate of 31/32 (96.8%). The peak systolic pressure gradient (mean (SD) decreased from 48.8 (23.5) to 2.2 (1.86) mm Hg (p<0.05). The diameter of the stenotic lesion increased from 5.6 (1.6) mm to 12.5 (2.6) (p<0.05). In one patient 2 stents were used because the first stent migrated downwards leaving the lesion partially uncovered. Nitinol stents were easier to deploy and conformed well to aortic walls. In the only unsuccessful case, the lesion was 12 mm long, tubular and did not yield even at 16 atm pressure. This case was taken up for elective surgery at a later date. There were no deaths or cerebrovascular events. Two cases had femoral artery access related problems (hematoma-1, loss of pulse-1). Twenty five of the 31 successful cases were on regular follow-up. On mean follow-up of 1.25 years one had re-coarctation and successful balloon dilation was done. Another case with re-coarctation and persistent hypertension underwent elective surgical repair. There were no aortic aneurysms in any case.


CONCLUSIONS
Stent implantation using this readily available low cost adult peripheral self-expanding stents gave gratifying, acute and early term results in treatment of coarctation of aorta in older children and adolescents. Ease of deployment, conforming to the aortic anatomy and low cost appear the main advantages of these stents.
Patnaik
Amar N
AN
Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, Andhra Pradesh, India. anpatnaik@yahoo.com
Srinivas
B
B
Rao
D S
DS
D000293:Adolescent; D000497:Alloys; D015906:Angioplasty, Balloon, Coronary; D001017:Aortic Coarctation / Q000628:therapy*; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D015607:Stents; D016896:Treatment Outcome
D000497:Alloys; C013616:nitinol