title: Stent placement versus surgery for coarctation of the thoracic aorta.
abstract: BACKGROUND
  Coarctation of the aorta (CoA) accounts for 5% to 7% of congenital heart disease, with an incidence of 0.3 to 0.4 per 1000 live births. Surgery was the only choice of therapy for CoA until 1982 when balloon angioplasty became an available alternative for its treatment. Re-coarctation, aneurysm and aortic dissection remain the disadvantages of both treatments. To avoid those disadvantages, in 1990 endovascular stents were introduced for native coarctation and re-coarctation and since then they have become an alternative approach to surgical repair. The best approach to treat the CoA, whether open surgery or by stent placement, is not clear.
  
  
  OBJECTIVE
  To analyze the effectiveness and safety of stent placement compared with open surgery in patients with coarctation of the thoracic aorta.
  
  
  METHODS
  The Cochrane Peripheral Vascular Diseases Group searched their Specialised Register (last searched September 2011) and CENTRAL (2011, Issue 3). We also searched MEDLINE, EMBASE, CINAHL, AMED, Web of Science and LILACS (last searched in September 2011). We evaluated the located references and applied the inclusion criteria to selected studies. There was no restriction on language.
  
  
  METHODS
  Randomized or quasi-randomized controlled clinical trials that compared patients with CoA undergoing open surgery or stent placement.
  
  
  METHODS
  The review authors independently assessed the studies identified for eligibility for inclusion. We excluded studies after a consensus meeting.
  
  
  RESULTS
  All identified studies were screened and had the selection criteria applied to the title and abstract. In total, we selected five studies for full-text analysis. After detailed evaluation, we excluded all studies because there was no comparison between stent placement and open surgery.
  
  
  CONCLUSIONS
  There is insufficient evidence with regards to the best treatment for coarctation of the thoracic aorta. This review suggests a need to perform a randomized controlled clinical trial with emphasis on the allocation method, evaluation of primary outcomes, size and quality of the sample, and long-term follow-up.
authors.affiliation: Department of EvidenceBasedHealthActions,MariliaMedical School, São Paulo, Brazil. laryssa.siqueira@gmail.com
authors.forename: Laryssa Maria Siqueira
authors.initials: LM
authors.lastname: Pádua
authors.forename: Lucas Cezar
authors.initials: LC
authors.lastname: Garcia
authors.forename: Claudio Jose
authors.initials: CJ
authors.lastname: Rubira
authors.forename: Paulo Eduardo
authors.initials: PE
authors.lastname: de Oliveira Carvalho
mesh_terms: D001017:Aortic Coarctation / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D015607:Stents