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. 2001 May;85(5):561–566. doi: 10.1136/heart.85.5.561

Endovascular stents in the management of coarctation of the aorta in the adolescent and adult: one year follow up

D Harrison 1, P McLaughlin 1, C Lazzam 1, M Connelly 1, L Benson 1
PMCID: PMC1729735  PMID: 11303011

Abstract

OBJECTIVES—To test the hypothesis that endovascular stents used with dilation of coarctation of the aorta (CoA) improve late outcomes. Balloon dilation for CoA has been limited by concerns over the risk for acute dissection, late restenosis, or aneurysm formation.
DESIGN—All patients seen with CoA between November 1994 and September 1997 underwent attempted stent implantation. Follow up was obtained for all patients and a subgroup (n = 18) had repeat catheterisation at a mean (SD) of 1.3 (0.5) years to assess residual gradient and stent-CoA morphology.
RESULTS—Stents were placed in 27 patients (15 male and 12 female patients, mean age 30.1 (13.1) years), of whom seven had prior surgical coarctectomy and one had a prior balloon dilation. Hypertension was present in 26 patients (mean pressure 164 (26)/86 (13) mm Hg), of whom 16 were on antihypertension drugs. CoA gradients were 46 (20) mm Hg (range 18-106 mm Hg) at baseline and 3 (5) mm Hg after the procedure. One patient had a stroke following the procedure; another patient had incomplete dilation and underwent a second procedure. At 1.8 (1) years after the procedure the mean pressure was 130 (14)/74 (11) mm Hg with seven patients on antihypertension treatment. The clinical gradient was 4 (8) mm Hg (range 0-32 mm Hg). At follow up angiography, the mean gradient was 4(6) mm Hg, and two patients had a gradient over 10 mm Hg. Aneurysms formed in three patients at the dilation site; one patient was referred for surgery.
CONCLUSION—In this age group stent management for CoA appears to be an effective technique and results in sustained reduction in CoA gradients at early term follow up, but aortic aneurysm was detected in 17% of patients who had repeat angiography.


Keywords: angioplasty; coarctation of the aorta; congenital heart defects; stents

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Figure 1  .

Figure 1  

Aortograms from a coarctation of the aorta before (left panel) and after stent implantation (middle and right panel). All angiograms were taken in the left anterior oblique projection.

Figure 2  .

Figure 2  

Pressure gradients at the coarctation of the aorta before, immediately after, and at follow up after stent implantation.

Figure 3  .

Figure 3  

Minimum diameters at the coarctation of the aorta before, immediately after, and at follow up after stent implantation.

Figure 4  .

Figure 4  

Left anterior oblique aortogram from the patient who developed a significant aneurysm requiring surgery, before (note filling of main pulmonary artery from a small arterial duct) (left) and after (middle) implantation. The right panel shows the appearance of the aneurysm noted angiographically at follow up (left anterior oblique projection).

graphic file with name hrt-tflm.f1.jpg

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