Abstract
Objectives. Stenting for native and recurrent coarctation (COA) in adults has become an important therapeutic strategy. In this prospective observational study we evaluated the intermediate-term outcome of stent implantation for either native or recurrent (re)COA in adults.
Methods. All adults who underwent stent implantation in our institution between January 2003 and December 2008 were included. Diagnosis of (re)COA was based upon a combination of clinical signs, noninvasive imaging or invasive gradient measurements. NuMED stents were implanted under general anaesthesia.
Results. Twenty-four patients (50% male) underwent stent implantation for native (n=6) or reCOA (n=18) at a median age of 36 (18 to 60) years. There was significant improvement in pre- versus post-stent invasive systolic gradient (19 vs. 0 mmHg, p<0.001) and COA diameter (10 vs. 16 mm, p<0.001). Acute complications (12.5%) included death due to aortic rupture despite immediate successful coverage with a covered stent (n=1) and groin haematoma (n=2). During a median follow-up period of 33 (8 to 77) months (n=22), late complications occurred in three patients (13.6%): stent migration to the ascending aorta (n=1), pseudoaneurysm at the site of the initial stent (n=1), and occluded external iliac artery (n=1). Stent implantation did not reduce the need for antihypertensive medication or blood pressure at last follow-up.
Conclusion. COA stenting results in a significant gradient decrease and increase in vessel diameter. However, serious complications do occur and hypertension remains in the majority of patients. (Neth Heart J 2010;18:430-6.)
Similar content being viewed by others
References
Mullins CE, O'Laughlin MP, Vick GW, 3rd, Mayer DC, Myers TJ, Kearney DL, et al. Implantation of balloon-expandable intravascular grafts by catheterization in pulmonary arteries and systemic veins. Circulation. 1988;77:188-99.
O'Laughlin MP, Perry SB, Lock JE, Mullins CE. Use of endovascular stents in congenital heart disease. Circulation. 1991;83:1923-39.
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.
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;139:1054-60.
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;85:561-6.
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.
Kenny D, Margey R, Turner MS, Tometzki AJ, Walsh KP, Martin RP. Self-expanding and balloon expandable covered stents in the treatment of aortic coarctation with or without aneurysm formation. Catheter Cardiovasc Interv. 2008;72:65-71.
Magee AG, Brzezinska-Rajszys G, Qureshi SA, Rosenthal E, Zubrzycka M, Ksiazyk J, et al. Stent implantation for aortic coarctation and recoarctation. Heart. 1999;82:600-6.
Redington AN, Hayes AM, Ho SY. Transcatheter stent implantation to treat aortic coarctation in infancy. Br Heart J. 1993;69:80-2.
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;30:1847-52.
Suarez de Lezo J, Pan M, Romero M, Medina A, Segura J, Pavlovic D, et al. Balloon-expandable stent repair of severe coarctation of aorta. Am Heart J. 1995;129:1002-8.
Musto C, Cifarelli A, Pucci E, Paladini S, De Felice F, Fiorilli R, et al. Endovascular treatment of aortic coarctation: long-term effects on hypertension. Int J Cardiol. 2008;130:420-5.
Chen SS, Donald AE, Storry C, Halcox JP, Bonhoeffer P, Deanfield JE. Impact of aortic stenting on peripheral vascular function and daytime systolic blood pressure in adult coarctation. Heart. 2008;94:919-24.
Vriend JW, Mulder BJ. Late complications in patients after repair of aortic coarctation: implications for management. Int J Cardiol. 2005;101:399-406.
Toro-Salazar OH, Steinberger J, Thomas W, Rocchini AP, Carpenter B, Moller JH. Long-term follow-up of patients after coarctation of the aorta repair. Am J Cardiol. 2002;89:541-7.
Gardiner HM, Celermajer DS, Sorensen KE, Georgakopoulos D, Robinson J, Thomas O, et al. Arterial reactivity is significantly impaired in normotensive young adults after successful repair of aortic coarctation in childhood. Circulation. 1994;89:1745-50.
Sehested J, Baandrup U, Mikkelsen E. Different reactivity and structure of the prestenotic and poststenotic aorta in human coarctation. Implications for baroreceptor function. Circulation. 1982;65:1060-5.
Gidding SS, Rocchini AP, Moorehead C, Schork MA, Rosenthal A. Increased forearm vascular reactivity in patients with hypertension after repair of coarctation. Circulation. 1985;71:495-9.
Pelech AN, Kartodihardjo W, Balfe JA, Balfe JW, Olley PM, Leenen FH. Exercise in children before and after coarctectomy: hemodynamic, echocardiographic, and biochemical assessment. Am Heart J. 1986;112:1263-70.
Swan L, Ashrafian H, Gatzoulis MA. Repair of coarctation: a higher goal? Lancet. 2002;359:977-8.
Carr JA. The results of catheter-based therapy compared with surgical repair of adult aortic coarctation. J Am Coll Cardiol. 2006;47:1101-7.
Thanopoulos BV, Eleftherakis N, Tzanos K, Skoularigis I, Triposkiadis F. Stent implantation for adult aortic coarctation. J Am Coll Cardiol. 2008;52:1815-6.
Tzifa A, Ewert P, Brzezinska-Rajszys G, Peters B, Zubrzycka M, Rosenthal E, et al. Covered Cheatham-platinum stents for aortic coarctation: early and intermediate-term results. J Am Coll Cardiol. 2006;47:1457-63.
Author information
Authors and Affiliations
Corresponding author
Additional information
Department of Cardiology, Thoraxcenter and Department of Internal Medicine, Division of Pharmacology, Vascular and Metabolic Diseases, Erasmus MC, Rotterdam, the Netherlands
Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, the Netherlands
Department of Cardio-Thoracic Surgery, Erasmus MC, Rotterdam, the Netherlands
Department of Cardiology, Thoraxcenter and Division of Paediatric Cardiology, Departments of Paediatrics, Erasmus MC, Rotterdam, the Netherlands
Erasmus MC Rotterdam, Room Ee1418a, PO Box 2040, 3000 CA Rotterdam, the Netherlands
Rights and permissions
About this article
Cite this article
Moltzer, E., Roos-Hesselink, J.W., Yap, S.C. et al. Endovascular stenting for aortic (re)coarctation in adults. NHJL 18, 430–436 (2010). https://doi.org/10.1007/BF03091810
Issue Date:
DOI: https://doi.org/10.1007/BF03091810