A Special Type of Complex Coarctation of Aorta with Total Lumen Occlusion Treated by Radiofrequency

Abstract

Coarctation of aorta (CoA) accounts for between 7% and 10% of cases of congenital heart disease1. Aortic atresia (complete aortic occlusion) is a special and very uncommon type characterized by the total abscence of distal flow, but with luminal continuity between the ascending and descending aorta. Normally occurs in cases of untreated long – standing CoA which progress to complete occlusion Diagnosis is usually established in the context of the study of HTA, stroke or heart failure. It´s usually accompained by extensive collateral circulation and degeneration of aortic wall which can trigger complication such as aneurysm and dissections or even aortic rupture. Surgical treatment is associated with a high rate of morbidity and mortality and for this reason percutaneous treatment has become relevant in recent years. It is performed by dual arterial access, due to the lenght of the occlussion , it couldn´t be crossed by angioplasty guidewire and we used a radiofrecuency catheter so as to cross. Once the occlusion was crossed we stablished a radial-femoral loop and then we proceeded to a progressive dilatation and finally a covered stent implantation. The collateral circulation is usually highly developed, which confers special surgical difficulty and risk on the procedure. This has led to the development of the percutaneous approach, with techniques for crossing the occluded segment using coronary angioplasty or radiofrequency guidewires (in cases of long occluded segments) and implantation of a stent, which should preferably be covered with ePTFE, The ePTFE stents could be recommended in this type of complex intervention in calcified aortas with a loss of structure due to medial cystic necrosis, which can progress to the formation of aneurysms, dissections, or even rupture. The stent should be positioned correctly in the wall with its ePTFE covering in order to reduce the incidence of complications