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Acute and intermediate outcomes, and evaluation of injury to the aortic wall, as based on 15 years experience of implanting stents to treat aortic coarctation

Published online by Cambridge University Press:  26 February 2007

Athar M. Qureshi ,
Doff B. McElhinney ,
James E. Lock ,
Michael J. Landzberg ,
Peter Lang  and
Audrey C. Marshall
Athar M. Qureshi
Affiliation:
Department of Cardiology, Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, United States of America
Doff B. McElhinney
Affiliation:
Department of Cardiology, Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, United States of America
James E. Lock
Affiliation:
Department of Cardiology, Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, United States of America
Michael J. Landzberg
Affiliation:
Department of Cardiology, Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, United States of America
Peter Lang
Affiliation:
Department of Cardiology, Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, United States of America
Audrey C. Marshall
Affiliation:
Department of Cardiology, Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, United States of America
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Abstract

Background: Stenting for aortic coarctation has been shown to be effective in the short term. The safety and longer term efficacy of transcatheter therapy, however, must be well established if the technique is to be widely accepted as an alternative to surgery. In order to determine the frequency, spectrum, and outcome of injury to the aortic wall caused by angioplasty or stenting of aortic coarctation, the nomenclature of mural injury in these patients must be adapted to the conditions of transcatheter therapy. Methods and Results: Between 1989 and July 2005, we inserted stents in 153 patients with aortic coarctation, their median age being 15.8 years. Prior aortic interventions had been performed in 98 patients, and preexisting aneurysms were observed in 19. Stenting resulted in a significant reduction of the gradient across the site of coarctation, from a median of 30 millimetres of mercury to zero (p less than 0.001), with a residual gradient within the aortic arch of 20 millimetres of mercury or more in 5% of patients. Acute injuries to the aortic wall, other than therapeutic tears, were observed in 3 patients (2%), none of whom required surgery. At median follow-up of 2.5 years, this being more than 5 years in 30 patients, 4 patients had died, albeit none from complications relating to stenting or catheterization. Acute injuries to the aortic wall did not progress, and new aneurysms were observed in 6% of patients subsequent to follow-up imaging. Stent fractures, and jailed or partially covered brachiocephalic vessels, were observed in 12, and 49, patients, respectively, but did not result in haemodynamic or embolic complications. Conclusions: Stenting for aortic coarctation results in consistent relief of the gradient, and few serious complications in the short and intermediate term. Serious injuries to the aortic wall are uncommon in our experience, and can be minimized with a focus on technical measures, such as pre-dilation before stenting.

Keywords

Aneurysmfunctionally single ventriclestent fractureaortic dissection
Type
Original Article
Information
Cardiology in the Young , Volume 17 , Issue 3 , June 2007 , pp. 307 - 318
Copyright
© 2007 Cambridge University Press

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References

O'Laughlin MP, Perry SB, Lock JE, Mullins CE. Use of endo- vascular stents in congenital heart disease. Circulation 1991; 83: 1923–1939.Google Scholar
Suarez de Lezo J, Pan M, Romero M, et al. Percutaneous interventions on severe coarctation of the aorta: a 21-year experience. Pediatr Cardiol 2005; 26: 176–189.Google Scholar
Pedra CA, Fontes VF, Esteves CA, et al. Stenting vs. balloon angioplasty for discrete unoperated coarctation of the aorta in adolescents and adults. Catheter Cardiovasc Interv 2005; 64: 495–506.Google Scholar
Johnston TA, Grifka RG, Jones TK. Endovascular stents for treatment of coarctation of the aorta: Acute results and follow-up experience. Catheter Cardiovasc Interv 2004; 62: 499–505.Google Scholar
Macdonald S, Thomas SM, Cleveland TJ, Gaines PA. Angioplasty or stenting in adult coarctation of the aorta? A retrospective single center analysis over a decade. Cardiovasc Intervent Radiol 2003; 26: 357–364.Google Scholar
Tyagi S, Singh S, Mukhopadhyay S, Kaul UA. Self- and balloon-expandable stent implantation for severe native coarctation of aorta in adults. Am Heart J 2003; 146: 920–928.Google Scholar
Zabal C, Attie F, Rosas M, Buendia-Hernandez A, Garcia- Montes JA. The adult patient with native coarctation of the aorta: balloon angioplasty or primary stenting? Heart 2003; 89: 77–83.Google Scholar
Harrison DA, McLaughlin PR, Lazzam C, Connelly M, Benson LN. Endovascular stents in the management of coarctation of the aorta in the adolescent and adult: one year follow up. Heart 2001; 85: 561–566.Google Scholar
Hamdan MA, Maheshwari S, Fahey JT, Hellenbrand WE. Endovascular stents for coarctation of the aorta: initial results and intermediate-term follow-up. J Am Coll Cardiol 2001; 38: 1518–1523.Google Scholar
Cheatham JP. Stenting of coarctation of the aorta. Catheter Cardiovas Interv 2001; 54: 112–125.Google Scholar
Ledesma M, Alva C, Gomez FD, et al. Results of stenting for aortic coarctation. Am J Cardiol 2001; 88: 460–462.Google Scholar
Marshall AC, Perry SB, Keane JF, Lock JE. Early results and medium-term follow-up of stent implantation for mild residual or recurrent aortic coarctation. Am Heart J 2000; 139: 1054–1060.Google Scholar
Thanopoulos BD, Hadjinikolaou L, Konstadopoulou GN, Tsaousis GS, Triposkiadis F, Spirou P. Stent treatment for coarctation of the aorta: intermediate term follow up and technical considerations. Heart 2000; 84: 65–70.Google Scholar
Magee AG, Brzezinska-Rajszys G, Qureshi SA, et al. Stent implantation for aortic coarctation and recoarctation. Heart 1999; 82: 600–606.Google Scholar
Suarez de Lezo J, Pan M, Romero M, et al. Immediate and follow-up findings after stent treatment for severe coarctation of aorta. Am J Cardiol 1999; 83: 400–406.Google Scholar
Ebeid MR, Prieto LR, Latson LA. Use of balloon-expandable stents for coarctation of the aorta: initial results and intermediate-term follow-up. J Am Coll Cardiol 1997; 30: 1847–1852.Google Scholar
Bulbul ZR, Bruckheimer E, Love JC, Fahey JT, Hellenbrand WE. Implantation of balloon-expandable stents for coarctation of the aorta: implantation data and short-term results. Cathet Cardiovasc Diagn 1996; 39: 36–42.Google Scholar
Oliver JM, Gallego P, Gonzalez A, Aroca A, Bret M, Mesa JM. Risk factors for aortic complications in adults with coarctation of the aorta. J Am Coll Cardiol 2004; 44: 1641–1647.Google Scholar
Hornung TS, Benson LN, McLaughlin PR. Interventions for aortic coarctation. Cardiol Rev 2002; 10: 139–148.Google Scholar
Siwik ES, Perry SB, Lock JE. Endovascular stent implantation in patients with stenotic aortoarteriopathies: early and medium-term results. Catheter Cardiovasc Interv 2003; 59: 380–386.Google Scholar
Korkola SJ, Tchervenkov CI, Shum-Tim D, Roy N. Aortic rupture after stenting of a native coarctation in an adult. Ann Thorac Surg 2002; 74: 936.Google Scholar
Varma C, Benson LN, Butany J, McLaughlin PR. Aortic dissection after stent dilatation for coarctation of the aorta: a case report and literature review. Catheter Cardiovasc Interv 2003; 59: 528–535.Google Scholar
Cowley CG, Orsmond GS, Feola P, McQuillan L, Shaddy RE. Long-term, randomized comparison of balloon angioplasty and surgery for native coarctation of the aorta in childhood. Circulation 2005; 111: 3453–3456.Google Scholar
Fawzy ME, Awad M, Hassan W, Al Kadhi Y, Shoukri M, Fadley F. Long-term outcome (up to 15 years) of balloon angioplasty of discrete native coarctation of the aorta in adolescents and adults. J Am Coll Cardiol 2004; 43: 1062–1067.Google Scholar
Ovaert C, McCrindle BW, Nykanen D, MacDonald C, Freedom RM, Benson LN. Balloon angioplasty of native coarctation: clinical outcomes and predictors of success. J Am Coll Cardiol 2000; 35: 988–996.Google Scholar
Zarins CK, Heikkinen MA, Hill BB. Aneurysmal vascular disease. In: Beachamp RD, Evers BM, Mattox KL (eds). Sabiston Textbook of Surgery, 17th edn. W.B. Saunders, Philadelphia, 2004, pp. 1965–1988.
Ewert P, Abdul-Khaliq H, Peters B, Nagdyman N, Schubert S, Lange PE. Transcatheter therapy of long extreme subatretic aortic coarctations with covered stents. Catheter Cardiovasc Interv 2004; 63: 236–239.Google Scholar
Ledesma M, Jauregui R, Ceron CK, et al. Stent fracture after stent therapy for aortic coarctation. J Invasive Cardiol 2003; 15: 719–721.Google Scholar
Scheinert D, Scheinert S, Sax J, et al. Prevalence and clinical impact of stent fractures after femoropopliteal stenting. J Am Coll Cardiol 2005; 45: 312–315.Google Scholar
Meier GH, Pollak JS, Rosenblatt M, Dickey KW, Gusberg RJ. Initial experience with venous stents in exertional axillary-subclavian vein thrombosis. J Vasc Surg 1996; 24: 974–981.Google Scholar
Peng LF, McElhinney DB, Nugent AW, et al. Endovascular stenting of obstructed right ventricle-to-pulmonary artery conduits: a 15-year experience. Circulation 2006; 113: 2598–2605.Google Scholar