title: Covered stents in the management of native coarctation of the aorta--intermediate and long-term follow-up.
abstract: OBJECTIVE
  To evaluate the results of covered Cheatham-Platinum stent implantation in the management of native coarctation of the aorta and report intermediate and long-term follow-up.
  
  
  BACKGROUND
  Covered stents are being used increasingly in severe and complex coarctation of the aorta mainly to reduce risk of aortic wall complications. There is, however, limited data on the intermediate and long-term outcome.
  
  
  METHODS
  Fifty-six patients received 59 covered Cheatham-Platinum stents (January 2002-December 2011) at a single center-in 54 patients as primary treatment and in 2 as a rescue. Mean age was 22.25 ± 1.2 (11-56) years and mean weight 58.6 ± 2.1 (32-99) kg. Primary end points were reduction in systolic pressure gradient and an increase in coarctation segment diameter. Changes in antihypertensive medicines and complications were recorded on follow-up.
  
  
  RESULTS
  Mean coarctation segment diameter increased from 4.69 ± 0.20 to 15.1 ± 3.2 mm (P < 0.0001). The systolic gradient decreased from mean of 51.4 ± 3.4 to 4.6 ± 0.7 mm Hg (P < 0.0001). There was one death 3 days postprocedure due to cerebral anoxia. There was one dissection diagnosed 24-hr postprocedure. At a mean follow-up of 45.9 ± 3.9 (3-120) months, all stents were patent and in good position on computed tomography. Four (7.1%) patients underwent successful redilation. Antihypertensive medication was decreased or stopped in 37 (66%) patients.
  
  
  CONCLUSIONS
  Covered Cheetham-Platinum stents may be used effectively as therapy of choice in selected patients with severe coarctation of the aorta. Aortic wall complications occur even with covered stents. Covered stents provide a safe alternative to conventional stenting in the intermediate and long-term and can be redilated safely to keep pace with somatic growth.
authors.affiliation: Punjab Institute of Cardiology and The Children's Hospital/The Institute of Child Health, Lahore, Pakistan.
authors.forename: Masood
authors.initials: M
authors.lastname: Sadiq
authors.forename: Asif
authors.initials: A
authors.lastname: Ur Rehman
authors.forename: Ahmad U
authors.initials: AU
authors.lastname: Qureshi
authors.forename: Shakeel A
authors.initials: SA
authors.lastname: Qureshi
mesh_terms: D000293:Adolescent; D000328:Adult; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation*; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001017:Aortic Coarctation / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D001027:Aortography / Q000379:methods; D001794:Blood Pressure; D002406:Catheterization, Peripheral; D002648:Child; D005260:Female; D006801:Humans; D006973:Hypertension / Q000503:physiopathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010984:Platinum; D011474:Prosthesis Design; D012039:Regional Blood Flow; D012720:Severity of Illness Index; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000959:Antihypertensive Agents; D010984:Platinum
keywords: complications adult cath/intervention; congenital heart disease in adults; hypertension