Abstract
To address elastic recoil of vessel wall and intimal dissection that can follow balloon angioplasty, stents have been designed and these appear to produce more effective relief of obstruction. Of the two types of stents, namely, balloon expandable and self expandable, balloon expandable stents are most commonly used in children. The usefulness of stents in the management of vascular obstructive lesions not amenable to balloon angioplasty is well established and has been successfully used to treat branch pulmonary artery stenosis, coarctation of the aorta, stenotic right ventricular outflow tract conduits, obstructive lesions of the systemic and pulmonary veins and others. The techniques of implantation, indications, immediate and follow-up results and complications were reviewed. The stents have also been effectively used in keeping open naturally occurring or artificially created inter-circulatory connections and as adjuncts in hybrid procedures, but these have not been discussed in this review. Future directions include investigative work on biodegradable stents and growth stents to address issues related to increase in vessel size in infants and children, use of drug eluding stents to prevent neo-intimal proliferation to avoid pulmonary vein restenosis and refinement of stent technology in hybrid procedures such as neonatal palliation of hypoplastic left heart syndrome and transcatheter completion of Fontan procedure. The feasibility, safety and effectiveness stents in the pediatric population are demonstrated, although scrutiny of results of larger experience with longer follow-up is important.
Highlights
Percutaneous balloon angioplasty has been proven effective [1]; elastic recoil of vessel wall and intimal dissection can result in ineffective relief of obstruction in some cases
Measurements made include the following: diameter of the stenotic lesion, diameter of the vessel proximal and distal to the obstruction, diameter of the contra-lateral branch pulmonary artery in branch pulmonary artery stenosis (BPAS) and “stentable” length of the vessel; all measurement are made in two orthogonal views
After the catheter is positioned distal to the obstruction, the wire is removed and exchanged for a 0.035” extra stiff Amplatz guide wire
Summary
Percutaneous balloon angioplasty has been proven effective [1]; elastic recoil of vessel wall and intimal dissection can result in ineffective relief of obstruction in some cases. Stents were used to treat obstructions in pulmonary arteries, systemic and pulmonary veins, aorta and right ventricular outflow tract (RVOT) conduits [12,13,14,15,16,17,18]. They were utilized to maintain patency of ductus arteriosus in pulmonary atresia and hypoplastic left heart syndrome [19,20,21], stenosed aortopulmonary collaterals [22,23] and surgically created but obstructed shunts [23,24]. Stents are helpful in accessing places inaccessible in conventional surgery
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