title: The "Dog Bone Technique" A Novel Easy and Safe Catheter Maneuver for Aortic Arch and Coarctation Stenting.
abstract: BACKGROUND
  Various techniques are described to facilitate stable stent implantation in aortic arch stenosis or coarctation. We describe an alternative technique, which due to its unique appearance during stent implantation, we have named "Dog Bone Technique" (DBT).
  
  
  METHODS
  The stent/balloon assembly is placed across the stenosis, the long sheath is retrieved to uncover the distal 20-50% of the stent. The balloon is inflated with the pressure inflator just to expand slightly the stent. Thereafter the sheath is pulled back and the proximal end is uncovered and partially inflated; therewith the assembly takes the typical "dog bone" shape before complete inflation and final positioning. Repositioning of the stent and control angiography is possible at each time of this procedure.
  
  
  RESULTS
  Between 1/2010 and 12/2014 we implanted 91 stents in 87 patients (mean age 20.2 years). About 71 patients had native or re-coarctation and 16 patients had transverse aortic arch stenosis. In 38 patients (44%) a pharmacological exercise test with Orciprenaline was performed during implantation resulting in high-cardiac output. In none of the patients reduction of cardiac output by adenosine or a rapid pacing of the right ventricle was required for stable stent implantation. All stents were implanted in the targeted position using this single balloon technique. There were no acute or short-term complications detected.
  
  
  CONCLUSIONS
  DBT is a safe and feasible technique for aortic stent implantation even at high-cardiac output. Other additional techniques for stent placement are not necessary to obtain a stable final position in the target region.
authors.affiliation: Department for Congenital Heart Defects, Heart and Diabetes Centre North Rhine Westphalia Ruhr University Bochum, Bad Oeynhausen, Germany.
authors.forename: Marinos
authors.initials: M
authors.lastname: Kantzis
authors.affiliation: Department for Pediatric Cardiology and Pediatric Intensive Care, Ludwig Maximilians University, Medical Hospital of the University of Munich, Campus Grosshadern, Munich, Germany.
authors.forename: Anja
authors.initials: A
authors.lastname: Lehner
authors.affiliation: Department for Congenital Heart Defects, Heart and Diabetes Centre North Rhine Westphalia Ruhr University Bochum, Bad Oeynhausen, Germany.
authors.forename: Kai Thorsten
authors.initials: KT
authors.lastname: Laser
authors.affiliation: Department for Congenital Heart Defects, Heart and Diabetes Centre North Rhine Westphalia Ruhr University Bochum, Bad Oeynhausen, Germany.
authors.forename: Anca
authors.initials: A
authors.lastname: Racolta
authors.affiliation: Department for Congenital Heart Defects, Heart and Diabetes Centre North Rhine Westphalia Ruhr University Bochum, Bad Oeynhausen, Germany.
authors.forename: Radka
authors.initials: R
authors.lastname: Vcasna
authors.affiliation: Department for Congenital Heart Defects, Heart and Diabetes Centre North Rhine Westphalia Ruhr University Bochum, Bad Oeynhausen, Germany.|Department for Pediatric Cardiology and Pediatric Intensive Care, Ludwig Maximilians University, Medical Hospital of the University of Munich, Campus Grosshadern, Munich, Germany.
authors.forename: Marcus
authors.initials: M
authors.lastname: Fischer
authors.affiliation: Department for Congenital Heart Defects, Heart and Diabetes Centre North Rhine Westphalia Ruhr University Bochum, Bad Oeynhausen, Germany.
authors.forename: Deniz
authors.initials: D
authors.lastname: Kececioglu
authors.affiliation: Department for Congenital Heart Defects, Heart and Diabetes Centre North Rhine Westphalia Ruhr University Bochum, Bad Oeynhausen, Germany.|Department for Pediatric Cardiology and Pediatric Intensive Care, Ludwig Maximilians University, Medical Hospital of the University of Munich, Campus Grosshadern, Munich, Germany.
authors.forename: Nikolaus A
authors.initials: NA
authors.lastname: Haas
mesh_terms: D000293:Adolescent; D000328:Adult; D000792:Angiography; D000800:Angioplasty, Balloon / Q000379:methods*; D001013:Aorta, Thoracic; D001017:Aortic Coarctation / Q000000981:diagnostic imaging / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents; D016896:Treatment Outcome; D055815:Young Adult