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Stenting across head and neck vessels using covered stents for persisting aortic arch obstruction

Published online by Cambridge University Press:  08 March 2012

James R. Bentham ,
Nilesh Oswal  and
Robert Yates
James R. Bentham
Affiliation:
Department of Paediatric Cardiology, Great Ormond Street Hospital, London, United Kingdom
Nilesh Oswal
Affiliation:
Department of Paediatric Cardiology, Great Ormond Street Hospital, London, United Kingdom
Robert Yates*
Affiliation:
Department of Paediatric Cardiology, Great Ormond Street Hospital, London, United Kingdom
*
Correspondence to: Dr R. Yates, MD, Department of Paediatric Cardiology, Great Ormond Street Hospital, London WC1N 3JH, United Kingdom. Tel: +44 2074059200; Fax: +44 2078138218; E-mail: [email protected]
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Abstract

Objective

To describe endovascular stent placement using partially covered stents to preserve flow in head and neck vessels.

Background

Endovascular stent placement has become established as a first-line therapy for native coarctation of the aorta or re-coarctation in older children and adults. Increasingly covered stents are becoming the preferred option over bare-metal stents because of the perceived lower risk of aneurysm formation. Open-cell bare-metal stents are chosen when there is a high likelihood of jailing a head and neck vessel. Here we describe partial uncovering of a covered stent before implantation to allow flow through the uncovered portion of the stent to the branch vessel but preserve the covering over the majority of the remaining stent.

Methods

We describe two cases with aortic arch hypoplasia and re-coarctation, both of which required two partially uncovered stents for a satisfactory result.

Conclusions

Endovascular stent placement is becoming the preferred option in the management of coarctation of the aorta in older children and adults. Strategies to deal with transverse arch hypoplasia and multiple levels of aortic arch obstruction frequently involving branch vessels or aneurysms need to be considered before these procedures are embarked upon. Partially uncovering stents may afford more protection than using bare-metal stents in the transverse and distal arch while preserving flow in head and neck branches, and is a technically straightforward procedure.

Keywords

Aortic coarctationcatheteraortic arch hypoplasia
Type
Brief Report
Information
Cardiology in the Young , Volume 22 , Issue 5 , 13 September 2012 , pp. 610 - 614
Copyright
Copyright © Cambridge University Press 2012

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