Implantation of new cobalt-chromium stents in the treatment of aortic coarctation

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Purpose: Stenting in Coarctation of the Aorta (CoA) has been performed with different stents. Recently new bare metal stent made of a Cobalt-Chromium (Co-Cr) alloy was introduced to clinical practice. They have hybrid open/closed cell design and are laser cut. We evaluated immediate result and midterm follow-up of implantation of this stents in the management of CoA at a single tertiary care center. Methods: Thirty five new type Co-Cr stents were implanted in 35 patients (pts): 30 with native CoA and 5 with recurrent after previous surgery (ReCoA). All had arterial hypertension in upper limbs, absent or weak femoral puls and continuous flow in abdominal aorta in Doppler examination. Mean patient age was 28,3±15,6 (ranged from 9 to 65) years. The stents were manually mounted on high pressure balloons and delivered through 10 to 14 Fr Mullins sheaths using a conventional femoral approach. Andrastent XL have expansion range till 25 mm, Andrastent XXL till 32 mm and both are different available lengths (from 13 till 57 mm). Results: All procedures were successful (no migration, proper expantion, no aorta dissection/rupture) – 15 XL Andrastents and 20 XXL were applied. In one pt (49 years old man) with severe secondary LV failure (EF 15%) the procedure was performed urgently during cardiogenic shock with good clinical result. The systolic gradient across the native CoA decreased from a mean 48,3±20,2 before to 11,9±10,2 mm Hg after the procedure and in case of ReCoA from 37,8±20,7 before to a mean 9,7±12,4 mm Hg after the procedure. The mean fluoroscopy time was 6,1±2,3 min. Procedural outcome remained favorable during mean follow-up 1,2±0,8. No aneurysm formation, stent fracture, dislocation were observed after the procedure in follow-up. Planned redilatation of implanted stent was performed between 4 and 14 months in 9 patients. In another 8 pts controlled angio CT was performed. Conclusions: Implantation of new large cobalt-chromium stents are very good therapeutical option for the treatment of native and recurrent CoA. Its strong radial force, flexibility and good radio-opacity is advantageous in implantation in CoA.