Elective implantation of covered stents for coarctation and recoarctation in adolescents and adults.
OBJECTIVE
Stent implantation is an effective therapy for aortic coarctation and recoarctation. However, in adolescents and adults, aortic wall rupture and dissection can occur, as well as aneurysms during follow-up. In order to reduce these complications, we electively implant covered stents.


METHODS
Since 2005, we have performed the procedure using femoral access in 17 patients (2 adolescents and 15 adults), 16 electively and 1 as a rescue procedure. We used the Mullins technique in all cases, implanting a NuMED(®) covered stent.


RESULTS
Good stent apposition was achieved in all 17 procedures; 8 patients required a distal flare. Gradient was reduced from 40 (16) mmHg to 2 (2) mmHg (P<.001) and lumen diameter increased from 4 (2) mm to 19 (3) mm (P<.001). Two exceptional cases are discussed: one patient with aortic wall rupture who underwent a rescue procedure using a stent within a covered stent and another patient with total obstruction and intercostal aneurysm in whom the outcome was fatal at 48 h postprocedure (autopsy is shown). Four-year clinical follow-up included Doppler echocardiography; an additional imaging technique was required in 13 patients. All patients recovered well and there were no complications.


CONCLUSIONS
Covered stents are effective in treating coarctation and recoarctation in adolescents and adults, are the treatment of choice in patients with complex anatomy, and must be available in the operating room as a rescue device when implanting a conventional stent.
Sección de Hemodinámica, Servicio de Cardiología, Hospital de Cruces, Barakaldo, Vizcaya, Spain.
Juan
J
Alcibar
Sección de Hemodinámica, Servicio de Cardiología, Hospital de Cruces, Barakaldo, Vizcaya, Spain. Electronic address: blancomata@yahoo.es.
Roberto
R
Blanco
Sección de Hemodinámica, Servicio de Cardiología, Hospital de Cruces, Barakaldo, Vizcaya, Spain.
Luis
L
Fernandez
Sección de Hemodinámica, Servicio de Cardiología, Hospital de Cruces, Barakaldo, Vizcaya, Spain.
Josune
J
Arriola
Sección de Hemodinámica, Servicio de Cardiología, Hospital de Cruces, Barakaldo, Vizcaya, Spain.
Koldobika
K
Garcia
Sección de Hemodinámica, Servicio de Cardiología, Hospital de Cruces, Barakaldo, Vizcaya, Spain.
Natividad
N
Peña
Sección de Hemodinámica, Servicio de Cardiología, Hospital de Cruces, Barakaldo, Vizcaya, Spain.
Ramón
R
Inguanzo
Servicio de Cirugía Cardiaca, Hospital de Cruces, Barakaldo, Vizcaya, Spain.
Roberto
R
Voces
Servicio de Cirugía Cardiaca, Hospital de Cruces, Barakaldo, Vizcaya, Spain.
Enrique
E
Castellanos
Sección de Hemodinámica, Servicio de Cardiología, Hospital de Cruces, Barakaldo, Vizcaya, Spain.
Pedro M
PM
Montes
D000293:Adolescent; D000328:Adult; D000368:Aged; D001017:Aortic Coarctation / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005263:Femoral Artery; D006801:Humans; D008297:Male; D008875:Middle Aged; D019919:Prosthesis Implantation / Q000379:methods*; D012008:Recurrence; D015607:Stents; D016896:Treatment Outcome; D014463:Ultrasonography; D055815:Young Adult