Percutaneous treatment of aortic isthmus atresia

Abstract

Limited data exists in the literature concerning the percutaneous treatment of complete aortic isthmus atresia. Between January 2007 and November 2010, 40 subjects underwent percutaneous treatment of aortic coarctation in our catheterization laboratory. Four out of 40 had aortic isthmus atresia with complete interruption. Median age at procedure was 48 years (range, 32-63 years). All subjects had history of arterial systemic hypertension refractory to medical treatment. Two subjects had a previous history of haemorrhagic stroke. All procedures were performed under general anesthesia and orotracheal intubation. In each case radial and femoral artery access was obtained. A radiofrequency (RF) system (Baylis MedComp Inc, Montreal, Canada) consisting of a Nykanen 0.024'' RFguidewire and coaxial microcatheter were used to perforate and cross the atretic segment. A guidewire was then snared and an artero-arterial circuit created. The area was predilated by using coronary angioplasty balloons. A 12 Fr Mullins long sheath was advanced and an E-PTFE covered 8Zig Cheatham-Platinum stent implanted. Patients were monitored in hospital for 48-72 hr. Follow-up was performed at 1, 3, 6, 12 months, and yearly thereafter. Percutaneous recanalization of the atretic segment was performed successfully in all subjects. Mean fluoroscopy and procedure times were 30 ± 6 and 90 ± 15 min, respectively. After implantation, the gradient decreased significantly (prestent: mean value 52.25 mm Hg [range 33-70 mm Hg] versus post stent: mean value 3 mm Hg [range, 0-10 mm Hg] [P < 0.0001]). The stents were placed in the correct position in all subjects and no immediate complications occurred. During a mean follow-up of 19 months (2-41 months), there were no significant complication. All subjects had arterial systemic blood pressure within the normal range. In two out of four patients single agent antihypertensive drug therapy was needed. The first patient in our series was treated conservatively and needed further stent dilation with a second procedure approach, eight months after the initial stent implantation, performed without incident. Our data show that use of radiofrequency energy perforation and covered CP stent implantation is a safe, effective, and promising tool for treatment of complete aortic isthmus atresia.