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. 1999 Nov;82(5):600–606. doi: 10.1136/hrt.82.5.600

Stent implantation for aortic coarctation and recoarctation

A Magee 1, G Brzezinska-Rajszy 1, S Qureshi 1, E Rosenthal 1, M Zubrzycka 1, J Ksiazyk 1, M Tynan 1
PMCID: PMC1760772  PMID: 10525517

Abstract

OBJECTIVE—To determine the early results of balloon expandable stent implantation for aortic coarctation or recoarctation.
DESIGN—Prospective observational study.
SETTING—Two paediatric cardiology tertiary referral centres.
PATIENTS—17 patients, median age 17 years (range 4.4 to 45) and median weight 61 kg (17 to 92). Six had native aortic coarctation and 11 had aortic recoarctation; 14 had upper limb systolic hypertension. Of those with recoarctation, eight had had at least one previous balloon dilatation attempt and two of these patients also had further surgical interventions.
INTERVENTION—Balloon expandable Palmaz iliac stent implantation.
MAIN OUTCOME MEASURES—Systolic pressures gradients, minimum aortic diameter, upper limb blood pressures, and incidence of aneurysm formation.
RESULTS—18 stents were implanted during 18 procedures in the 17 patients. Mean peak systolic pressure gradient fell from 26 mm Hg (95% confidence interval (CI), 21 to 31 mm Hg) before to 5 mm Hg (2 to 8 mm Hg) after stent implantation (p < 0.001), and mean minimum aortic diameter increased from 7 mm (95% CI, 6 to 8 mm) before to 11.3 mm (10 to 12.6 mm) after implantation (p < 0.001). Complications occurred in five patients (bleeding in two, stent migration in two, and aneurysm formation in one). Two patients remained borderline hypertensive and eight were receiving antihypertensive treatment at most recent assessment.
CONCLUSIONS—Stent implantation for aortic recoarctation and native coarctation gives good immediate results. Careful follow up is necessary to evaluate complications and the long term effect on blood pressure.


Keywords: coarctation; aortic recoarctation; stents

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Figure 1  .

Figure 1  

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(A) Long axis aortogram using a "marker" pigtail catheter showing discrete native coarctation in a patient who also had severe aortic valve stenosis. (B) Repeat aortogram following expansion of a Palmaz 4014 stent using an 18 mm "Cristal" balloon. The stent is partially covering the origin of the left subclavian artery.

Figure 2  .

Figure 2  

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(A) Follow up spiral computed tomography (CT) with contrast showing stented aorta in cross section. (B) Axial three dimensional reconstruction of CT images in the same patient showing no evidence of aneurysm formation.

Figure 3  .

Figure 3  

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Three dimensional reconstruction of spiral computed tomographic images with contrast taken nine months after stent implantation in the patient shown in fig 1. The stent has been outlined in a different shade of grey from the aorta. Note continued patency of the left subclavian artery.

Selected References

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

  1. Anjos R., Qureshi S. A., Rosenthal E., Murdoch I., Hayes A., Parsons J., Baker E. J., Tynan M. Determinants of hemodynamic results of balloon dilation of aortic recoarctation. Am J Cardiol. 1992 Mar 1;69(6):665–671. doi: 10.1016/0002-9149(92)90161-q. [DOI] [PubMed] [Google Scholar]
  2. Aydogan U., Dindar A., Gurgan L., Cantez T. Late development of dissecting aneurysm following balloon angioplasty of native aortic coarctation. Cathet Cardiovasc Diagn. 1995 Nov;36(3):226–229. doi: 10.1002/ccd.1810360307. [DOI] [PubMed] [Google Scholar]
  3. Balaji S., Oommen R., Rees P. G. Fatal aortic rupture during balloon dilatation of recoarctation. Br Heart J. 1991 Feb;65(2):100–101. doi: 10.1136/hrt.65.2.100. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Blum U., Langer M., Spillner G., Mialhe C., Beyersdorf F., Buitrago-Tellez C., Voshage G., Düber C., Schlosser V., Cragg A. H. Abdominal aortic aneurysms: preliminary technical and clinical results with transfemoral placement of endovascular self-expanding stent-grafts. Radiology. 1996 Jan;198(1):25–31. doi: 10.1148/radiology.198.1.8539389. [DOI] [PubMed] [Google Scholar]
  5. Bromberg B. I., Beekman R. H., Rocchini A. P., Snider A. R., Bank E. R., Heidelberger K., Rosenthal A. Aortic aneurysm after patch aortoplasty repair of coarctation: a prospective analysis of prevalence, screening tests and risks. J Am Coll Cardiol. 1989 Sep;14(3):734–741. doi: 10.1016/0735-1097(89)90119-8. [DOI] [PubMed] [Google Scholar]
  6. Bulbul Z. R., Bruckheimer E., Love J. C., Fahey J. T., Hellenbrand W. E. Implantation of balloon-expandable stents for coarctation of the aorta: implantation data and short-term results. Cathet Cardiovasc Diagn. 1996 Sep;39(1):36–42. doi: 10.1002/(SICI)1097-0304(199609)39:1<36::AID-CCD7>3.0.CO;2-3. [DOI] [PubMed] [Google Scholar]
  7. Fletcher S. E., Nihill M. R., Grifka R. G., O'Laughlin M. P., Mullins C. E. Balloon angioplasty of native coarctation of the aorta: midterm follow-up and prognostic factors. J Am Coll Cardiol. 1995 Mar 1;25(3):730–734. doi: 10.1016/0735-1097(94)00437-U. [DOI] [PubMed] [Google Scholar]
  8. Harrison J. K., Sheikh K. H., Davidson C. J., Kisslo K. B., Leithe M. E., Himmelstein S. I., Kanter R. J., Bashore T. M. Balloon angioplasty of coarctation of the aorta evaluated with intravascular ultrasound imaging. J Am Coll Cardiol. 1990 Mar 15;15(4):906–909. doi: 10.1016/0735-1097(90)90291-v. [DOI] [PubMed] [Google Scholar]
  9. Hellenbrand W. E., Allen H. D., Golinko R. J., Hagler D. J., Lutin W., Kan J. Balloon angioplasty for aortic recoarctation: results of Valvuloplasty and Angioplasty of Congenital Anomalies Registry. Am J Cardiol. 1990 Mar 15;65(11):793–797. doi: 10.1016/0002-9149(90)91390-r. [DOI] [PubMed] [Google Scholar]
  10. Hijazi Z. M., Fahey J. T., Kleinman C. S., Hellenbrand W. E. Balloon angioplasty for recurrent coarctation of aorta. Immediate and long-term results. Circulation. 1991 Sep;84(3):1150–1156. doi: 10.1161/01.cir.84.3.1150. [DOI] [PubMed] [Google Scholar]
  11. Ho S. Y., Somerville J., Yip W. C., Anderson R. H. Transluminal balloon dilation of resected coarcted segments of thoracic aorta: histological study and clinical implications. Int J Cardiol. 1988 Apr;19(1):99–105. doi: 10.1016/0167-5273(88)90195-7. [DOI] [PubMed] [Google Scholar]
  12. Huggon I. C., Qureshi S. A., Baker E. J., Tynan M. Effect of introducing balloon dilation of native aortic coarctation on overall outcome in infants and children. Am J Cardiol. 1994 Apr 15;73(11):799–807. doi: 10.1016/0002-9149(94)90884-2. [DOI] [PubMed] [Google Scholar]
  13. Ino T., Kishiro M., Okubo M., Akimoto K., Nishimoto K., Yabuta K., Kawasaki S., Hosoda Y. Dilatation mechanism of balloon angioplasty in children: assessment by angiography and intravascular ultrasound. Cardiovasc Intervent Radiol. 1998 Mar-Apr;21(2):102–108. doi: 10.1007/s002709900224. [DOI] [PubMed] [Google Scholar]
  14. Knyshov G. V., Sitar L. L., Glagola M. D., Atamanyuk M. Y. Aortic aneurysms at the site of the repair of coarctation of the aorta: a review of 48 patients. Ann Thorac Surg. 1996 Mar;61(3):935–939. doi: 10.1016/0003-4975(95)01189-7. [DOI] [PubMed] [Google Scholar]
  15. Lock J. E., Castaneda-Zuniga W. R., Bass J. L., Foker J. E., Amplatz K., Anderson R. W. Balloon dilatation of excised aortic coarctations. Radiology. 1982 Jun;143(3):689–691. doi: 10.1148/radiology.143.3.6210934. [DOI] [PubMed] [Google Scholar]
  16. McCrindle B. W., Jones T. K., Morrow W. R., Hagler D. J., Lloyd T. R., Nouri S., Latson L. A. Acute results of balloon angioplasty of native coarctation versus recurrent aortic obstruction are equivalent. Valvuloplasty and Angioplasty of Congenital Anomalies (VACA) Registry Investigators. J Am Coll Cardiol. 1996 Dec;28(7):1810–1817. doi: 10.1016/s0735-1097(96)00379-8. [DOI] [PubMed] [Google Scholar]
  17. Mendelsohn A. M., Dorostkar P. C., Moorehead C. P., Lupinetti F. M., Reynolds P. I., Ludomirsky A., Lloyd T. R., Heidelberger K., Beekman R. H., 3rd Stent redilation in canine models of congenital heart disease: pulmonary artery stenosis and coarctation of the aorta. Cathet Cardiovasc Diagn. 1996 Aug;38(4):430–440. doi: 10.1002/(SICI)1097-0304(199608)38:4<430::AID-CCD24>3.0.CO;2-H. [DOI] [PubMed] [Google Scholar]
  18. Mendelsohn A. M., Lloyd T. R., Crowley D. C., Sandhu S. K., Kocis K. C., Beekman R. H., 3rd Late follow-up of balloon angioplasty in children with a native coarctation of the aorta. Am J Cardiol. 1994 Oct 1;74(7):696–700. doi: 10.1016/0002-9149(94)90312-3. [DOI] [PubMed] [Google Scholar]
  19. Morrow W. R., Smith V. C., Ehler W. J., VanDellen A. F., Mullins C. E. Balloon angioplasty with stent implantation in experimental coarctation of the aorta. Circulation. 1994 Jun;89(6):2677–2683. doi: 10.1161/01.cir.89.6.2677. [DOI] [PubMed] [Google Scholar]
  20. O'Laughlin M. P., Perry S. B., Lock J. E., Mullins C. E. Use of endovascular stents in congenital heart disease. Circulation. 1991 Jun;83(6):1923–1939. doi: 10.1161/01.cir.83.6.1923. [DOI] [PubMed] [Google Scholar]
  21. Palmaz J. C., Richter G. M., Noeldge G., Schatz R. A., Robison P. D., Gardiner G. A., Jr, Becker G. J., McLean G. K., Denny D. F., Jr, Lammer J. Intraluminal stents in atherosclerotic iliac artery stenosis: preliminary report of a multicenter study. Radiology. 1988 Sep;168(3):727–731. doi: 10.1148/radiology.168.3.2970098. [DOI] [PubMed] [Google Scholar]
  22. Parks W. J., Ngo T. D., Plauth W. H., Jr, Bank E. R., Sheppard S. K., Pettigrew R. I., Williams W. H. Incidence of aneurysm formation after Dacron patch aortoplasty repair for coarctation of the aorta: long-term results and assessment utilizing magnetic resonance angiography with three-dimensional surface rendering. J Am Coll Cardiol. 1995 Jul;26(1):266–271. doi: 10.1016/0735-1097(95)00127-l. [DOI] [PubMed] [Google Scholar]
  23. Pethig K., Wahlers T., Tager S., Borst H. G. Perioperative complications in combined aortic valve replacement and extraanatomic ascending-descending bypass. Ann Thorac Surg. 1996 Jun;61(6):1724–1726. doi: 10.1016/0003-4975(96)00140-3. [DOI] [PubMed] [Google Scholar]
  24. Pinzon J. L., Burrows P. E., Benson L. N., Moës C. A., Lightfoot N. E., Williams W. G., Freedom R. M. Repair of coarctation of the aorta in children: postoperative morphology. Radiology. 1991 Jul;180(1):199–203. doi: 10.1148/radiology.180.1.2052694. [DOI] [PubMed] [Google Scholar]
  25. Rao P. S., Galal O., Smith P. A., Wilson A. D. Five- to nine-year follow-up results of balloon angioplasty of native aortic coarctation in infants and children. J Am Coll Cardiol. 1996 Feb;27(2):462–470. doi: 10.1016/0735-1097(95)00479-3. [DOI] [PubMed] [Google Scholar]
  26. Rosenthal E., Qureshi S. A., Tynan M. Stent implantation for aortic recoarctation. Am Heart J. 1995 Jun;129(6):1220–1221. doi: 10.1016/0002-8703(95)90408-5. [DOI] [PubMed] [Google Scholar]
  27. Schatz R. A., Palmaz J. C., Tio F. O., Garcia F., Garcia O., Reuter S. R. Balloon-expandable intracoronary stents in the adult dog. Circulation. 1987 Aug;76(2):450–457. doi: 10.1161/01.cir.76.2.450. [DOI] [PubMed] [Google Scholar]
  28. Schräder R., Bussmann W. D., Jacobi V., Kadel C. Long-term effects of balloon coarctation angioplasty on arterial blood pressure in adolescent and adult patients. Cathet Cardiovasc Diagn. 1995 Nov;36(3):220–225. doi: 10.1002/ccd.1810360306. [DOI] [PubMed] [Google Scholar]
  29. Serruys P. W., de Jaegere P., Kiemeneij F., Macaya C., Rutsch W., Heyndrickx G., Emanuelsson H., Marco J., Legrand V., Materne P. A comparison of balloon-expandable-stent implantation with balloon angioplasty in patients with coronary artery disease. Benestent Study Group. N Engl J Med. 1994 Aug 25;331(8):489–495. doi: 10.1056/NEJM199408253310801. [DOI] [PubMed] [Google Scholar]
  30. Tynan M., Finley J. P., Fontes V., Hess J., Kan J. Balloon angioplasty for the treatment of native coarctation: results of Valvuloplasty and Angioplasty of Congenital Anomalies Registry. Am J Cardiol. 1990 Mar 15;65(11):790–792. doi: 10.1016/0002-9149(90)91389-n. [DOI] [PubMed] [Google Scholar]
  31. Witsenburg M., The S. H., Bogers A. J., Hess J. Balloon angioplasty for aortic recoarctation in children: initial and follow up results and midterm effect on blood pressure. Br Heart J. 1993 Aug;70(2):170–174. doi: 10.1136/hrt.70.2.170. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Xu J., Shiota T., Omoto R., Zhou X., Kyo S., Ishii M., Rice M. J., Sahn D. J. Intravascular ultrasound assessment of regional aortic wall stiffness, distensibility, and compliance in patients with coarctation of the aorta. Am Heart J. 1997 Jul;134(1):93–98. doi: 10.1016/s0002-8703(97)70111-x. [DOI] [PubMed] [Google Scholar]

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