Abstract
For over 11 years, endovascular treatment by angioplasty (PTA) alone or stenting of adult coarctation at a single center was evaluated. We retrospectively reviewed 28 consecutive patients (31 interventions), median age 25 years, treated between 1991 and 2002, 20 of whom had native coarctation. Thirteen patients had PTA alone (16 procedures) (10 “kissing balloon” angioplasty comprising 12 interventions, and 3 single balloon angioplasty comprising 4 interventions) and 15 patients were stented (15 procedures), including 6 secondary and 9 primary stents. There were no procedural or 30-day complications. For the whole group, the median follow-up was 6.6 years (range 1–10 years). In the PTA group, median follow-up was 9 years (range 3–10) and in the stenting group it was 3 years (range 1–5). There were 9 restenoses in the PTA group (6 after “kissing balloons” and 3 after single balloon) comprising 56% of the angioplasties (9/16 procedures). There was 1 restenosis in the stenting group diagnosed at computed tomography (CT). The patient was clinically well. For the whole group there were significant reductions in systolic blood pressure (BP) (p = 0.0003), diastolic BP (p = 0.004) and number of drugs per patient (p = 0.045) at latest follow-up post-treatment. Five patients discontinued therapy. Analysis of the groups revealed that the reduction of systolic and diastolic BP and number of drugs did not reach statistical significance in the PTA group but were significant in the stent group. The endovascular management of adult coarctation is safe. Stents may be more effective than PTA alone but longer-term follow-up of stents is required.
Similar content being viewed by others
References
PS Rao (1995) ArticleTitleCoarctation of the aorta. Semin Nephrol 15 87–105
M Campbell (1970) ArticleTitleNatural history of coarctation of the aorta. Br Heart J 32 633–640 Occurrence Handle1:STN:280:CS6D3cnitVw%3D Occurrence Handle5470045
S Westaby B Parnell RB Pridie (1987) ArticleTitleCoarctation of the aorta in adults. Clinical presentation and results of surgery. J Cardiovasc Surg 28 124–127
WJ Wells TW Prendergast F Berdjis D Brandl PE Lange R Hetzer VA Starnes (1996) ArticleTitleRepair of coarctation of the aorta in adults: The fate of systolic hypertension. Ann Thorac Surg 61 1168–1171 Occurrence Handle10.1016/0003-4975(96)00008-2 Occurrence Handle1:STN:280:BymC1c3itVE%3D Occurrence Handle8607677
SR Schuster RE Gross (1961) ArticleTitleSurgery for coarctation of the aorta: A review of 500 cases. J Thoracic Cardiovasc Surg 43 54–69
J. de Giovanni (2001) ArticleTitleCovered stents in the treatment of aortic coarctation. J Interven Cardiol 14 187–190 Occurrence Handle1:STN:280:DC%2BD38zht1Shtw%3D%3D
DA Harrison PR McLaughlin C Lazzam M Connelly LN Benson (2001) ArticleTitleEndovascular stents in the management of coarctation of the aorta in the adolescent and adult: One year follow-up. Heart 85 561–566 Occurrence Handle10.1136/heart.85.5.561 Occurrence Handle1:STN:280:DC%2BD3M3ms1Wjsg%3D%3D Occurrence Handle11303011
GP Ussia M Marasini G Pongiglione (2001) ArticleTitleParaplegia following percutaneous balloon angioplasty of the aortic coarctation: A case report. Catheter Cardiovasc Intervent 54 510–513 Occurrence Handle10.1002/ccd.1322 Occurrence Handle1:STN:280:DC%2BD3Mnps12ltg%3D%3D
T Ino M Kishiro M Okubo K Akimoto K Nishimoto K Yabuta S Kawasaki Y Hosoda (1998) ArticleTitleDilatation mechanism of balloon angioplasty in children: Assessment by angiography and intravascular ultrasound. Cardiovasc Intervent Radiol 21 102–108
JK Harrison KH Shekh CJ Davidson KB Kisslo ME Leithe SI Himmelstein RJ Kanter TM Bashore (1990) ArticleTitleBalloon angioplasty of coarctation of the aorta evaluated with intravascular ultrasound imaging. J Am Coll Cardiol 15 906–909
A Rothman F Ricou RG Weintraub R Crowley R Arcangeli T Shiota J Zhang DJ Sahn (1992) ArticleTitleIntraluminal ultrasound imaging through a balloon dilatation catheter in an animal model of coarctation of the aorta. Circulation 85 2291–2295 Occurrence Handle1:STN:280:By2B2svlsF0%3D Occurrence Handle1591843
AD Tong A Rothman RL Atkinson T Shiota F Ricou DJ Sahn (1995) ArticleTitleIntravascular ultrasound imaging of coarctation of the aorta: Animal and human studies. Am J Card Imaging 9 250–256 Occurrence Handle1:STN:280:BymC3M3jsVM%3D Occurrence Handle8680141
S Sohn A Rothman T Shiota G Luk A Tong RE Swensson DJ Sahn (1994) ArticleTitleAcute and follow-up intravascular ultrasound findings after balloon dilatation of coarctation of the aorta. Circulation 90 340–347 Occurrence Handle1:STN:280:ByuB1MfhslU%3D Occurrence Handle8026016
JM Isner RF Donaldson D Fulton I Bhan DD Payne RJ Cleveland (1987) ArticleTitleCystic medial necrosis in coarctation of the aorta: A potential factor contributing to adverse consequences observed after percutaneous balloon angioplasty of coarctation sites. Circulation 75 689–695 Occurrence Handle1:STN:280:BiiC2MbptFI%3D Occurrence Handle2951035
AG Magee G Brezezinska-Rajszys SA Qureshi E Rosenthal M Zubrzycka J Ksiazyk M Tynan (1999) ArticleTitleStent implantation for aortic coarctation and recoarctation. Heart 82 600–606 Occurrence Handle1:STN:280:DyaK1Mvlslaiug%3D%3D Occurrence Handle10525517
BD Thanopoulos L Hadjinikolaou GN Konstadopoulou GS Tsaousis F Triposkiadis P Spirou (2000) ArticleTitleStent treatment for coarctation of the aorta: Intermediate term follow-up and technical considerations. Heart 84 65–70 Occurrence Handle10.1136/heart.84.1.65 Occurrence Handle1:STN:280:DC%2BD3czitFajtg%3D%3D Occurrence Handle10862593
AC Marshall CA Perry JF Keane JE Lock (2000) ArticleTitleEarly results and medium-term follow-up of stent implantation for mild residual or recurrent aortic coarctation. Am Heart J 139 1054–1060 Occurrence Handle10.1067/mhj.2000.106616 Occurrence Handle1:STN:280:DC%2BD3c3oslarsQ%3D%3D Occurrence Handle10827387
J Suarez de Lezo M Pan M Romero A Medina J Segura M Lafuente D Pavlovic E Hernandez F Melian J Espada (1999) ArticleTitleImmediate and follow-up findings after stent treatment for severe coarctation of aorta. Am J Cardiol 83 400–406 Occurrence Handle10.1016/S0002-9149(98)00877-7 Occurrence Handle1:STN:280:DyaK1M7ntVCnug%3D%3D Occurrence Handle10072232
MR Ebeid LR Prieto LA Latson (1997) ArticleTitleUse of balloon-expandable stents for coarctation of the aorta: Initial results and intermediate-term follow-up. J Am Coll Cardiol 30 1847–1852
JW Kirklin BG. Barratt-Boyes (1993) Cardiac surgery: morphology, diagnostic criteria, natural history, techniques, results and indications, 2nd ed Churchill Livingston New York 1285
K Forfang H Rostad S Sorland (1981) ArticleTitleCoarctation of the aorta: Follow-up of 218 patients operated on after 13 years of age. Acta Med Scand (Suppl) 645 15–22 Occurrence Handle1:STN:280:Bi6B3cznslU%3D
ED Foster (1984) ArticleTitleReoperation for aortic coarctation. Ann Thorac Surg 38 81–89 Occurrence Handle1:STN:280:BiuB3s%2FjtFM%3D Occurrence Handle6375606
RH Beekman AP Rocchini DM Behrendt A Rosenthal (1981) ArticleTitleReoperation for coarctation of the aorta. Am J Cardiol 48 1108–1114
LA III Brewer RG Fosburg GA Mulder JJ Verska (1972) ArticleTitleSpinal cord complications following surgery for coarctation of the aorta: A study of 66 cases. J Thorac Cardiovasc Surg 64 368–381 Occurrence Handle5054875
JE Connolly (1998) ArticleTitleHume Memorial Lecture. Prevention of spinal cord complications in aortic surgery. Am J Surg 176 92–101 Occurrence Handle10.1016/S0002-9610(98)00133-0 Occurrence Handle1:STN:280:DyaK1cvgslKhug%3D%3D Occurrence Handle9737610
AP Kappetein AH Zwinderman AJ Bogers J Rohmer HA Huysmans (1994) ArticleTitleMore than thirty-five years of coarctation repair: An unexpected high relapse rate. J Thorac Cardiovasc Surg 107 87–95 Occurrence Handle1:STN:280:ByuC3M7mtFM%3D Occurrence Handle8283924
AJ Paddon AA Nicholson DF Ettles SJ Travis JF Dyet (2000) ArticleTitleLong-term follow-up of percutaneous balloon angioplasty in adult aortic coarctation. Cardiovasc Intervent Radiol 23 364–367
ME Fawzy V Sivanandam O Galal B Dunn A Patel A Rifai W von Sinner Z Al Halees B Khan (1997) ArticleTitleOne- to ten-year follow-up of balloon angioplasty of native coarctation of the aorta in adolescents and adults. J Am Coll Cardiol 30 1542–1546
R Schrader Jacobi Bussmann W-D Kadel V . C (1995) ArticleTitleLong-term effects of balloon coarctation angioplasty on arterial blood pressure in adolescent and adult patients. Cathet Cardiovasc Diagn 36 220–225 Occurrence Handle1:STN:280:BymC38jit1M%3D Occurrence Handle8542628
J Koerselman H de Vries W Jaarsma L Muyldermans JMPG Ernst HWM. Plokker (2000) ArticleTitleBalloon angioplasty of coarctation of the aorta: A safe alternative for surgery in adults: Immediate and mid-term results. Cathet Cardiovasc Int 50 28–33 Occurrence Handle10.1002/(SICI)1522-726X(200005)50:1<28::AID-CCD6>3.3.CO;2-4 Occurrence Handle1:STN:280:DC%2BD3c3ns1GrtQ%3D%3D
Z Bulbul E Bruckheimer JC Love JT Fahey WE Hellenbrand (1996) ArticleTitleImplantation of balloon-expandable stents for coarctation of the aorta: Implantation data and short-term results. Cathet Cardiovasc Diagn 39 36–42 Occurrence Handle10.1002/(SICI)1097-0304(199609)39:1<36::AID-CCD7>3.3.CO;2-Z Occurrence Handle1:STN:280:ByiD38fptlU%3D Occurrence Handle8874943
MA Hamdan S Maheshwari JT Fahey WE Hellenbrand (2001) ArticleTitleEndovascular stents for coarctation of the aorta: Initial results and intermediate-term follow-up. J Am Coll Cardiol 38 1518–1523
ME Fawzy B Dunn O Galal N Wilson A Shaikh R Sriram CM Duran (1992) ArticleTitleBalloon coarctation angioplasty in adolescents and adults: Early and intermediate results. Am Heart J 124 167–171 Occurrence Handle1:STN:280:By2A3M3ktlw%3D Occurrence Handle1535473
S Tyagi R Arora UA Kaul KK Sethi DS Ghambir M Khalilullah (1992) ArticleTitleBalloon angioplasty of native coarctation of the aorta in adolescents and young adults. Am Heart J 123 674–680 Occurrence Handle1:STN:280:By2C2s%2FmvVw%3D Occurrence Handle1531722
DG Ray R Subramanyan T Titus J Tharakan J Joy CG Venkitachalam KG Balakrishnan (1992) ArticleTitleBalloon angioplasty for native coarctation of the aorta in children and adults: Factors determining the outcome. Int J Cardiol 36 273–281
M Ledesma C Alva FD Gomez A Sanchez-Soberanis DY Diaz C Benitez-Perez R Herrera-Franco R Arguero T Feldman (2001) ArticleTitleResults of stenting for aortic coarctation. Am J Cardiol 88 460–462 Occurrence Handle10.1016/S0002-9149(01)01705-2 Occurrence Handle1:STN:280:DC%2BD3Mvps1Gmsg%3D%3D Occurrence Handle11545780
C Duke SA Qureshi (2001) ArticleTitleAortic coarctation and recoarctation: To stent or not to stent. J Intervent Cardiol 3 283–298
A Beitzke JI Stein A Gamillscheg B Rigler (1997) ArticleTitleDissection of the descending aorta after balloon angioplasty of the native coarctation. Pediatr Cardiol 18 222–225
U Aydogan A Dindar L Gurgan T Cantez (1995) ArticleTitleLate development of dissecting aneurysm following balloon angioplasty of native aortic coarctation. Cathet Cardiovasc Diagn 36 226–229 Occurrence Handle1:STN:280:BymC38jit1w%3D Occurrence Handle8542629
S Balaji R Oommen PG Rees (1991) ArticleTitleAortic rupture during balloon dilatation of recoarctation. Br Heart J 65 100–101 Occurrence Handle1:STN:280:By6A38bht1A%3D Occurrence Handle1831032
J Cheatham S Fletcher C Foreman S Froemming (1998) ArticleTitleEarly experience using endovascular stents in children with coarctation of the aorta: Promising results but proceed with caution [abstract]. Cardiol Young 9 IssueIDsuppl 1 11
SE Fletcher JP Cheatham S Froeming (1998) ArticleTitleAortic aneurysm following primary balloon angioplasty and secondary endovascular stent placement in the treatment of native coarctation of the aorta [see comments]. Cathet Cardiovasc Diagn 44 40–44 Occurrence Handle10.1002/(SICI)1097-0304(199805)44:1<40::AID-CCD10>3.3.CO;2-Y Occurrence Handle1:STN:280:DyaK1c3mtFWnug%3D%3D Occurrence Handle9600521
J Gunn TJ Cleveland P Gaines (1999) ArticleTitleCovered stent to treat coexistent coarctation and aneurysm of the aorta in a young man. Heart 82 351 Occurrence Handle1:STN:280:DyaK1Mzoslagtg%3D%3D Occurrence Handle10455088
S Rao (1997) ArticleTitleStents in treatment of aortic coarctation. Editorial comment. JACC 30 1853–1855 Occurrence Handle1:STN:280:DyaK1c%2FksFKrtw%3D%3D Occurrence Handle9385918
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Macdonald, S., Thomas, S., Cleveland, T. et al. Angioplasty or Stenting in Adult Coarctation of the Aorta? A Retrospective Single Center Analysis Over a Decade . CVIR 26, 357–364 (2003). https://doi.org/10.1007/s00270-003-2709-7
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00270-003-2709-7