title: Stenting of aortic coarctation: acute, intermediate, and long-term results of a prospective multi-institutional registry--Congenital Cardiovascular Interventional Study Consortium (CCISC).
abstract: BACKGROUND
  Since the 1980s, stent implantation has evolved as an important therapeutic strategy for coarctation of the aorta. However, available data is frequently flawed by short follow-up, lack of adequate follow-up imaging, and retrospective nature of data collection.
  
  
  METHODS
  Data was prospectively collected using a multicenter registry congenital cardiovascular interventional study consortium (CCISC). Between 2000 and 2009, 302 patients from 34 centers with a median weight of 58 kg underwent stent implantation for coarctation. Eligible patients (44%) completed intermediate follow-up (3-18 months) with integrated imaging (cath, CT, MRI), whereas 21% completed long-term follow-up (>18-60 months). Procedural success was defined as UL/LL systolic gradient of less than 20 mm Hg, lack of significant recurrent obstruction, and freedom from unplanned repeat intervention.
  
  
  RESULTS
  Acute procedural success was 96%. Cumulative intermediate success was 86%, and cumulative long-term success was 77%. Unplanned repeat interventions were required in 4%, and aortic wall complications were seen in 1% of patients (dissection n = 1 and aneurysm n = 3). Other adverse events (n = 15) occurred mainly acutely and included technical complications such as stent malposition (n = 9). At long-term follow-up, 23% of patients continued to have systolic blood pressure above the 95th centile, 9% had an upper-to-lower limb blood pressure gradient in excess of 20 mm Hg, and 32% were taking antihypertensive medication.
  
  
  CONCLUSIONS
  This study documented acute, intermediate, and long-term outcome data comparable or superior with other surgical or interventional series. However, even with successful initial stent therapy, patients continue to require long-term follow-up and have associated long-term morbidity, relating to aortic wall complications, systemic hypertension, recurrent obstruction as well as need for repeat intervention.
authors.affiliation: The Heart Center, Nationwide Children's Hospital Columbus, Columbus, Ohio 43205, USA. Ralf.Holzer@Nationwidechildrens.org
authors.forename: Ralf
authors.initials: R
authors.lastname: Holzer
authors.forename: Shakeel
authors.initials: S
authors.lastname: Qureshi
authors.forename: Abdolrahim
authors.initials: A
authors.lastname: Ghasemi
authors.forename: Julie
authors.initials: J
authors.lastname: Vincent
authors.forename: Horst
authors.initials: H
authors.lastname: Sievert
authors.forename: Daniel
authors.initials: D
authors.lastname: Gruenstein
authors.forename: Howard
authors.initials: H
authors.lastname: Weber
authors.forename: Luis
authors.initials: L
authors.lastname: Alday
authors.forename: Alejandro
authors.initials: A
authors.lastname: Peirone
authors.forename: Thomas
authors.initials: T
authors.lastname: Zellers
authors.forename: John
authors.initials: J
authors.lastname: Cheatham
authors.forename: Michael
authors.initials: M
authors.lastname: Slack
authors.forename: Jonathan
authors.initials: J
authors.lastname: Rome
mesh_terms: D000293:Adolescent; D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001017:Aortic Coarctation / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D001118:Argentina; D002170:Canada; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation*; D005260:Female; D006439:Hemodynamics; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011474:Prosthesis Design; D012008:Recurrence; D012042:Registries; D019233:Retreatment; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult
chemical_list: D000959:Antihypertensive Agents