Abstract
Background: Endovascular stenting is the preferred option in managing coarctation of aorta (COA) in older children and adults. Covered stents are used in selected or high risk category of patients. We present our experience with stenting of coarctation of aorta.
Materials and Methods: Patients with severe coarctation of aorta who underwent endovascular stenting during the period July 2013 to July 2016 were retrospectively analysed. CT aortogram was used for pre procedural imaging. Procedural outcome complications and short term follow up were noted.
Results: 22 patients (seven females) aged 1-52 years (median 29), weighing 7.8 -86.4 (median 55.1) kg, underwent stenting of COA. All except one had post subclavian coarctation. 68.2% of patients had hypertension and were on treatment. Mean gradient at catheterisation was 71.7 ± 28.6 mm hg and mean gradient post procedure was 3.6 ± 4.4 mmhg. A total of 22 stents were deployed, Covered CP (12), Cook Formula (1), Advanta V12 Atrium (2), Intrastent Mega(3), Palmaz (2), Andrastent.(1),Bare CP (1). Covered stents were used in 59.1%.The mean stent length was 35 ± 12.5 mm. Pre dilatation was done in two patients including one with near interruption. Post dilatation was needed in 36.4% of patients. Procedural complications included retroperitoneal hemorrhage in one which resulted in mortality. Follow-up ranged from 1 month to 3.5 years. 36.4% required continuation of antihypertensive therapy even after stenting. One patient with presubclavian coarctation required redilatation 6 months after stenting.
Conclusions: Stent implantation is a safe and effective alternative to surgical repair in COA. It provides immediate and near complete relief of obstruction which is sustained on short term follow up. Long term follow up is required to look for restenosis, aneurysm formation and persistent systemic hypertension.
References
1. Hoffman JI, Kaplan S. The incidence of congenital heart disease. J Am Collcardiol. 2002;39:1890–900.[PubMed]
2. Campbell M. Natural history of coarctation of the aorta. Br Heart J. 1970;32:633–40. [PMC free article][PubMed]
3. Adams FH, Emmanouildes GC, Riemenschneider TA (1989) Moss’ Heart Disease in Infants, Children and Adolescents. (4thedn), Williams & Wilkins, Baltimore.
4. Crafoord O, Nylin G (1945) Congenital coarctation of the aorta and its surgical treatment. J ThoracSurg 14: 347-361.
5. Gross RE, Hufnagal CA (1945) Coarctation of the aorta: experimental studies regarding its surgical correction. N Engl J Med 233: 287-293.
6. 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. [PMC free article] [PubMed]
7. Hamdan MA, Maheshwari S, Fahey JT, Hellenbrand WE. Endovascular stents for coarctation of the aorta: initial results and intermediate-term follow-up. J Am CollCardiol. 2001;38:1518–23. [PubMed]
8. Fawzy ME, Sivanandam V, Galal O, et al. One- to ten-year follow-up results of balloon angioplasty of native coarctation of the aorta in adolescents and adults. J Am CollCardiol. 1997;30:1542–6. [PubMed]
9. Phadke K, Dyet JF, Aber CP, Hartley W. Balloon angioplasty of adult aortic coarctation. Br Heart J. 1993;69:36–40. [PMC free article] [PubMed]
10. Forbes TJ, Garekar S, Amin Z, et al. Procedural results and acute complications in stenting native and recurrent coarctation of the aorta in patients over 4 years of age: a multi-institutional study. Catheter CardiovascInterv. 2007;70:276 85. [PubMed]
11. Eicken A, Pensl U, Sebening W, et al. The fate of systemic blood pressure in patients after effectively stented coarctation. Eur Heart J. 2006;27:1100–5. [PubMed]
12. Moltzer E, Roos-Hesselink JW, Yap SC, et al. Endovascular stenting for aortic (re) coarctation in adults. Neth Heart J. 2010;18:430–6. [PMC free article] [PubMed]
13. Chessa M, Carrozza M, Butera G, et al. Results and mid-long-term followup of stent implantation for native and recurrent coarctation of the aorta. Eur Heart J. 2005;26:2728–32. [PubMed]
14. Golden AB, Hellenbrand WE. Coarctation of the aorta: stenting in children and adults. Catheter CardiovascInterv. 2007; 69:289–99. [PubMed]
15. Mahadevan VS, Vondermuhll IF, Mullen MJ. Endovascular aortic coarctation stenting in adolescents and adults: angiographic and hemodynamic outcomes. Catheter CardiovascInterv. 2006;67:268–75. [PubMed]
16. Chen SS, Donald AE, Storry C, et al. Impact of aor tic stenting on peripheral vascular function and daytime systolic blood pressure in adult coarctation. Heart. 2008;94:919–24. [PubMed]
17. Karl TR. Surgery is the best treatment for primary coarctation in the majority of cases. J Cardiovasc Med (Hagerstown) 2007;8:50–6. [PubMed]
18. Tanous D, Collins N, Dehghani P, Horlick EM, Benson LN. Covered stents in the management of coarctation of the aorta in the adult: initial results and 1-year angiographic and hemodynamic follow-up. Int J Cardiol. 2010;140:287 95. [PubMed]
19. Dotter CT, Judkin MP. Transluminal treatment of atherosclerotic obstruction. Circulation. 1964;30:654-70.
20. O’Laughlin MP, Perry SB, Lock JE, Mullins CE. Use of endovascular stents in congenital heart disease. Circulation. 1991;83:1923-39
21. Redington AN, Hayes AM, Ho SY. Transcatheter stent
implantation to treat aortic coarctation in infancy. Br Heart J.1993;69(1):80-2.
22. Suarez de Lezo J, Pan M, Romero M, Medina A, Segura J, Pavlovic D, et al. Balloon expandable stent repair of severe
coarctation of the aorta. Am Heart J. 1995;129:1002-8.
23. Rao PS. Stents in the management of congenital heart disease in the pediatric and adult patients.Indian Heart J.2001;53:714- 30
24. Doshi AR, Rao PS. Coarctation of aorta-Management options and decision making. PediatrThrapeut. 2012;S5:006
25. Forbes TJ, Kim DW, Du W, Turner DR, Holzer R, Amin Z, et al. CCISC Investigators. Comparison of surgical, stent, and balloon angioplasty treatment of native coarctation of the aorta: an observational study by the CCISC (Congenital Cardiovascular Interventional Study Consortium). J Am CollCardiol. 2011;58:2664-7
26. Cardiac Catheterization and Imaging (From Pediatrics to Geriatrics) IB Vijayalakshmi MD DM FICC FIAMS FIAE FCSI FICP FAMS DSc Professor of Pediatric Cardiology Sri Jayadeva Institute of Cardiovascular Sciences and Research Bengaluru, Karnataka, India.
DOI: https://dx.doi.org/10.18535/jmscr/v5i5.185
