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Initial experience using the NuMED Cheatham Platinum (CP) stent for interventional treatment of coarctation of the aorta in children and adolescents

Erste Ergebnisse mit dem NuMED Cheatham-Platinum(CP)-Stent zur interventionellen Behandlung der Aortenisthmusstenose im Kindesalter

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Zusammenfassung

Wir berichten über unsere ersten Ergebnisse bei der Behandlung der nativen oder residuellen Aortenisthmusstenose mit dem neuen Cheatham-Platinum (CP)-Stent.

Die CP-Stents wurden bei 6 Patienten (mittleres Alter 12,7 Jahre) aufgrund einer Aortenisthmusstenose (5 native Stenosen, 1 Reststenose) implantiert. Der maximale systolische Druckgradient konnte von 49 auf 3 mmHg (p <0,001) verringert werden. Der mittlere Gefäßdurchmesser im Bereich der Aortenisthmusstenose erweiterte sich um 350% (von 3,8 auf 13,8 mm, p <0,01). Obwohl der maximale Durchmesser der Stents von 8 bis 18 mm variierte, kam es lediglich zu einer trivialen Verkürzung der eingesetzten Stents (max. 11%). Die Dilatation war bei allen Patienten erfolgreich und komplikationslos.

Bei allen Patienten bestand vor der Intervention ein Hypertonus und drei Patienten wurden entsprechend antihypertensiv medikamentös therapiert. Bei 2 Patienten wurde auf eine maximale Gefäßdilatation während der initialen Implantation verzichtet, da der initiale Gefäßdurchmesser sehr gering war (ca. 1 mm). Bei diesen Patienten wurde eine erneute Dilatation nach Ablauf von 12 Monaten durchgefuhrt und die Stents auf Aortendurchmesser erweitert. Im aktuellen Beobachtungszeitraum von derzeit 18 Monaten sind 5 von 6 Patienten normotensiv und ohne Medikation. Hinweise für eine erneute Stenosierung, Dissektion, Aneurysmabildung oder Malposition der Stents ergaben sich bislang nicht.

Die hier dargestellten Ergebnisse verdeutlichen, dass die neuartigen CP-Stents zur interventionellen Therapie von Aortenisthmusstenosen bei einem großen Spektrum unterschiedlicher Gefäßdurchmesser erfolgreich eingesetzt werden können. Somit stellt diese Therapie eine effektive Alternative zur Operation oder alleinigen Ballondilatation auch im Kindesalter dar. Die Möglichkeit der großzügigen Redilatation ohne wesentliche Verkürzung macht die CP-Stents besonders attraktiv für Patienten im Wachstumsalter.

Summary

We report the immediate results in a group of selected patients with native or recurrent coarctation of the aorta who underwent endovascular stent implantation using the newly designed Cheatham-Platinum (CP)-stent.

The balloon-expandable stents were implanted in 6 patients (mean age 12.7 years) with coarctation of the aorta (5 native, 1 recurrent). The maximal systolic peak pressure gradient was decreased from 49 to 3 mmHg (p <0.001). There was a 350% increase in the mean diameter at the original coarctation site (3.8 to 13.8 mm, p <0.01). Although the maximal diameter varied from 8 to 18 mm, there was only a minor reduction in the length of the CP-stents used (max. 11%). The dilatation was successful in all patients and there were no complications during balloon dilatation or stent implantation.

All patients were hypertensive prior to stent implantation, with three of them requiring antihypertensive drug therapy. In 2 patients only a moderate dilatation diameter was chosen initially due to the extremely small coarctation site (1 mm) and repeat dilatation after 12 months was performed in order to obtain a maximal aortic diameter. At a mean of 18 months of follow-up, 5 of 6 patients are normotensive. There is no recurrence of coarctation, aortic dissection or aneurysm formation and no stent displacement.

These findings suggest that the implantation of CP-stents for coarctation of the aortamay cover a wide spectrum of aortic diameters and consequently hereby offer an effective alternative approach to surgery or ballon dilatation alone even in infancy and childhood. The potential for redilatation of CP-stents in a wide range of diameters without significant shortening adds to the benefit of this device in growing children.

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Authors and Affiliations

  1. Director of the Paediatric Intensive Care Unit, The Prince Charles Hospital, Brisbane Rode Raod, Chermside Old 4032, Austria

    N. A. Haas

  2. Department of Paediatrics III, Paediatric Cardiology and Paediatric Intensive Care, Adult Congenital Heart Defects, Olgahospital Stuttgart, Bismarckstraße 8, 70176, Stuttgart, Germany

    M. A. G. Lewin,  W. Knirsch,  R. Nossal,  V. Ocker &  F. Uhlemann

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  1. N. A. Haas
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  2. M. A. G. Lewin
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  3. W. Knirsch
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  4. R. Nossal
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Correspondence to N. A. Haas.

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Haas, N.A., Lewin, M.A.G., Knirsch, W. et al. Initial experience using the NuMED Cheatham Platinum (CP) stent for interventional treatment of coarctation of the aorta in children and adolescents. ZS Kardiologie 94, 113–120 (2005). https://doi.org/10.1007/s00392-005-0180-y

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