title: Percutaneous treatment of adult isthmic aortic coarctation: acute and long-term clinical and imaging outcome with a self-expandable uncovered nitinol stent.
abstract: BACKGROUND
  To present perioperative and long-term results of percutaneous treatment of adult isthmic coarctation of the aorta by means of a self-expandable closed-web uncovered nitinol stent (Sinus-XL, Optimed, Esslingen, Germany).
  
  
  RESULTS
  Preoperative, perioperative, and long-term clinical and computed tomographic angiography data were collected and analyzed prospectively. A total of 52 consecutive patients were treated with the Sinus-XL stent. Mean age was 36.6 (21-67) years, peak invasive trans-coarctation of the aorta gradient was 54.7 ± 9.9 mm Hg, and upper body hypertension unresponsive to medical treatment was present in all patients. Mean stent diameter and length were 24.2 mm (22-28 mm) and 70.4 mm (40-80 mm), respectively. Eight patients (15.4%) required coarctation of the aorta predilatation. All patients underwent poststent dilatation with a noncompliant balloon. Postoperative peak gradient (3.3 ± 2.5 mm Hg) was reduced significantly (P < 0.001) and minimal aortic diameter was increased significantly (4.6 ± 1.9 versus 18.6 ± 2.5 mm; P < 0.001). All patients were discharged home (mean hospitalization, 3.5 days). At follow-up (47.6 months; 12-84), 1 (1.9%) noncardiovascular mortality was reported. Aortic computed tomography confirmed the absence of stent collapse and secondary migration and documented stability in aortic diameter (18.3 ± 2.7 mm). Thirty patients (57.7%) were completely weaned-off antihypertensive medications and their use dropped from 2.6 to 0.9 drugs/patient (P < 0.001). Ankle-brachial pressure index increased from 0.75 to 0.98 (P < 0.001).
  
  
  CONCLUSIONS
  Adult coarctation of the aorta treatment by means of a self-expandable uncovered stent is safe and durable. The peculiar stent design maintains adequate localized radial strength over time with minimal trauma on the adjacent aortic wall and negligible device-related complications. Blood pressure control optimization is immediate and persistent even at long-term follow-up.
authors.affiliation: From the Department of Cardiology, Vivantes Klinikum im Friedrichshain und Am Urban, Berlin, Germany, and Rostock University Medical Center, Rostock, Germany (S.K., G.D., Y.S., J.O., H.I.); and Klinikum Oldenburg, Herz-Kreislauf Zentrum, Klinik Für Kardiologie, Oldenburg, Germany (A.E.).
authors.forename: Stephan
authors.initials: S
authors.lastname: Kische
authors.affiliation: From the Department of Cardiology, Vivantes Klinikum im Friedrichshain und Am Urban, Berlin, Germany, and Rostock University Medical Center, Rostock, Germany (S.K., G.D., Y.S., J.O., H.I.); and Klinikum Oldenburg, Herz-Kreislauf Zentrum, Klinik Für Kardiologie, Oldenburg, Germany (A.E.). rgea@hotmail.com.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: D'Ancona
authors.affiliation: From the Department of Cardiology, Vivantes Klinikum im Friedrichshain und Am Urban, Berlin, Germany, and Rostock University Medical Center, Rostock, Germany (S.K., G.D., Y.S., J.O., H.I.); and Klinikum Oldenburg, Herz-Kreislauf Zentrum, Klinik Für Kardiologie, Oldenburg, Germany (A.E.).
authors.forename: Yannik
authors.initials: Y
authors.lastname: Stoeckicht
authors.affiliation: From the Department of Cardiology, Vivantes Klinikum im Friedrichshain und Am Urban, Berlin, Germany, and Rostock University Medical Center, Rostock, Germany (S.K., G.D., Y.S., J.O., H.I.); and Klinikum Oldenburg, Herz-Kreislauf Zentrum, Klinik Für Kardiologie, Oldenburg, Germany (A.E.).
authors.forename: Jasmin
authors.initials: J
authors.lastname: Ortak
authors.affiliation: From the Department of Cardiology, Vivantes Klinikum im Friedrichshain und Am Urban, Berlin, Germany, and Rostock University Medical Center, Rostock, Germany (S.K., G.D., Y.S., J.O., H.I.); and Klinikum Oldenburg, Herz-Kreislauf Zentrum, Klinik Für Kardiologie, Oldenburg, Germany (A.E.).
authors.forename: Albrecht
authors.initials: A
authors.lastname: Elsässer
authors.affiliation: From the Department of Cardiology, Vivantes Klinikum im Friedrichshain und Am Urban, Berlin, Germany, and Rostock University Medical Center, Rostock, Germany (S.K., G.D., Y.S., J.O., H.I.); and Klinikum Oldenburg, Herz-Kreislauf Zentrum, Klinik Für Kardiologie, Oldenburg, Germany (A.E.).
authors.forename: Hüseyin
authors.initials: H
authors.lastname: Ince
mesh_terms: D000328:Adult; D000368:Aged; D000497:Alloys; D000792:Angiography; D055109:Ankle Brachial Index; D001017:Aortic Coarctation / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation; D003952:Diagnostic Imaging; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D011446:Prospective Studies; D015607:Stents; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000497:Alloys; C013616:nitinol
keywords: adult; aortic coarctation; percutaneous transluminal angioplasty; stents