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. 2000 Jul;84(1):65–70. doi: 10.1136/heart.84.1.65

Stent treatment for coarctation of the aorta: intermediate term follow up and technical considerations

B Thanopoulos 1, L Hadjinikolaou 1, G Konstadopoulou 1, G Tsaousis 1, F Triposkiadis 1, P Spirou 1
PMCID: PMC1729403  PMID: 10862593

Abstract

OBJECTIVE—To report the initial and intermediate term results of stent implantation in children with coarctation of the aorta.
PATIENTS AND DESIGN—17 patients with coarctation of the aorta underwent stent implantation (median age 11 years, range 0.4-15 years); six were treated for isolated coarctation, nine for recurrent coarctation (five after surgical repair and four after balloon dilatation), and two for complex long segment coarctation.
INTERVENTIONS—The procedure was guided by a second catheter placed transseptally in the left ventricle or the aorta proximal to the coarctation site, for angiographic and haemodynamic monitoring during the procedure. Twenty two stents were implanted in 17 patients. One of the patients with long segment coarctation received four stents and the other three. Palmaz 4014 stents were placed in 11 patients, Palmaz 308 in five, and Palmaz 154 in one.
RESULTS—Immediately after stent implantation the peak systolic gradient (mean (SD)) fell from 50.0 (24.5) to 2.1 (2.4) mm Hg (p < 0.05). The diameter of the stenotic lesion increased from 5.1 (1.5) mm to 13.9 (2.4) mm (p < 0.05). There were no deaths or procedure related complications. At a median follow up of 33 months, no cases of recoarctation were identified, either clinically (0/17; 0%, 95% confidence interval (CI) 0% to 19%) or angiographically (0/13; 0%, 95% CI 0% to 25%).
CONCLUSIONS—Stent implantation for the treatment of coarctation of the aorta appears to have very low morbidity and mortality, and reasonable intermediate term results. Long term freedom from recoarctation using this method remains to be determined in comparison with simple balloon dilatation.


Keywords: aortic coarctation; blood vessel prostheses; stents

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Figure 1  .

Figure 1  

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Antegrade ascending aortograms in the anteroposterior (1) and lateral (2) projections, showing the position of a stent across the coarctation before expansion. Repeat anteroposterior (3) and lateral (4) aortogram projections showed an aortic diameter of 13 mm at the stented segment and good stent position. Retrograde anteroposterior (5) and lateral (6) ascending aortogram projections 36 months later showed no evidence of restenosis and good stent position without fracture or displacement (patient 2, tables 1 and 2).

Figure 2  .

Figure 2  

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Antegrade ascending aortograms (left panels) and simultaneous ascending and descending aortic pressure tracings (right panels) obtained from a patient with long segment coarctation before (A) and immediately after (B) multiple stent implantation. An impressive increase in coarctation diameter and elimination of the pressure gradient across the coarctation is seen after deployment of the stents (patient 7, tables 1 and 2).

Figure 3  .

Figure 3  

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Ascending aortograms in the anteroposterior (1) and lateral (2) projections, revealing a discrete recoarctation in a 4 month old infant after a left subclavian flap operation. Left ventriculography in the anteroposterior (3) and lateral (4) projections show the position of a stent across the coarctation before expansion. Left ventriculography in the anteroposterior (5) and lateral (6) projections show a reasonable increase in coarctation diameter following stent placement (patient 1, tables 1 and 2).

Figure 4  .

Figure 4  

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Descending aortograms showing the treatment of a long segment coarctation of aorta with multiple stents. Picture 1 shows the upper part of the coarctation and picture 2 the lower part. Picture 3 shows the descending aorta immediately after placement of four stents. Pictures 4 and 5 show follow up aortograms one and six years after the procedure, respectively. There was no significant change in the aortic diameter at the stented area. Picture 6 shows a plain film radiograph six years after the procedure. Notice the mild stent dislodgement at the junctions between the first and second, as well as the third and fourth stents (arrowheads) (patient 7, tables 1 and 2).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

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