Placement of balloon-expandable stents in coarcation of the aorta: Initial results and short-term follow up

Abstract

We report preliminary result and short term follow up (up to 5 years)of balloon-expandable stents for the coarctation of the aorta (COA). Using balloon-expandable stents gained acceptance over the past years, as a modality of treatment for COA. However, use of these stents may create disruption of the aortic wall or aneurysm at the stents end points. Our experience using Palmaz stent in half of the patients mounted on a balloon dilatation catheter. The rest of the patients received Covered CP Stent. All patients had significant improvement without any complications. Twenty five patents with mean age 18 years range from 9 to 45 with COA underwent stent implantation. Nine patients were diagnosed with native COA and 16 had previous surgical, balloon dilatation or both, to relieve their coarcation; but had residual/recurrent gradient. A femoral vessels access performed for such procedure and angio-grams were obtained pre and post stent implantation. BP was continuously monitored during the procedure. All patients were maintained on aspirin for at least 6 months post procedure. Immediately after stent implantation the peak systolic gradient (mean (SD)) fell from 35 mm Hg (15.6) to 3.8 (4.3) (mm Hg). ( p < 0.05). The diameter of the stenotic lesion increased from 6.5 (3.0) to13.5 (3.0) mm ( p < 0.05). There were no deaths or procedure related complications. Measured one day after stent placement, the descending aorta velocity dropped from (mean (SD)) 3.7 (0.58) m/s to 2.3 (0.6) m/s. ( p < 0.05). At median follow up of 24 months, the clinical gradient dropped from (mean (SD)) 36 (18) mm Hg pre intervention to 4 (9) p < 0.05) mm Hg. Seven patient (28%) required re-dilatation at a later stage for re-stenosis. The average systolic and diastolic blood pressure at follow up was at the 5th percentile. Nine patients (28%) were still on antihypertensive medications compare to 13 patients (52%) at the time of stent implantation. Stent implantation for the treatment of coarctation of the aorta appears to have very low morbidity and mortality, and reasonable intermediate term results. A long term follow up is needed.