Stent implantation for aortic coarctation and recoarctation

Abstract

Objective - To determine the early results of balloon expandable stent implantation for aortic coarctation or recoarctation. Design - Prospective observational study. Setting - Two paediatric cardiology tertiary referral centres. Patients - 17 patients, median age 17 years (range 4.4 to 45) and median weight 61 kg (17 to 92). Six had native aortic coarctation and 11 had aortic recoarctation; 14 had upper limb systolic hypertension. Of those with recoarctation, eight had had at least one previous balloon dilatation attempt and two of these patients also had further surgical interventions. Intervention - Balloon expandable Palmaz iliac stent implantation. Main outcome measures - Systolic pressures gradients, minimum aortic diameter, upper limb blood pressures, and incidence of aneurysm formation. Results - 18 stents were implanted during 18 procedures in the 17 patients. Mean peak systolic pressure gradient fell from 26 mm Hg (95% confidence interval (CI), 21 to 31 mm Hg) before to 5 mm Hg (2 to 8 mm Hg) after stent implantation (p < 0.001), and mean minimum aortic diameter increased from 7 mm (95% CI, 6 to 8 mm) before to 11.3 mm (10 to 12.6 mm) after implantation (p < 0.001). Complications occurred in five patients (bleeding in two, stent migration in two, and aneurysm formation in one). Two patients remained borderline hypertensive and eight were receiving antihypertensive treatment at most recent assessment. Conclusions - Stent implantation for aortic recoarctation and native coarctation gives good immediate results. Careful follow up is necessary to evaluate complications and the long term effect on blood pressure.