Use of Balloon-Expandable Stents for Coarctation of the Aorta: Initial Results and Intermediate-Term Follow-Up

J Am Coll Cardiol. 1997 Dec;30(7):1847-52. doi: 10.1016/s0735-1097(97)00408-7.

Abstract

Objectives: In this study we report our preliminary results and intermediate-term follow-up (up to 3.5 years) of stent implantation for coarctation of the aorta (COA).

Background: Balloon angioplasty has gained acceptance as a modality of treatment for COA. Some patients do not respond optimally to balloon angioplasty alone. Balloon-expandable stents have been used in pulmonary arteries and large systemic arteries such as the femoroiliac vessels, with a significant improvement in vessel patency and a reduction in the pressure gradient compared with balloon angioplasty alone.

Methods: Nine patients (>10 years old) with COA in whom balloon dilation alone was thought to be ineffective underwent stent implantation. Seven patients had a previous operation or balloon dilation, or both, to relieve their coarctation but had a significant residual/recurrent gradient.

Results: At the time of stent implantation, the systolic and mean gradients decreased from a mean (+/-SEM) of 37 +/- 7 and 14 +/- 3 mm Hg to 4 +/- 1 and 2 +/- 0.6 mm Hg, respectively (p < or = 0.002). The coarctation diameter increased from a mean of 9 +/- 1 to 15 +/- 1 mm (p < 0.002). The patients have been followed for up to 42 months (mean 18, median 13) with no complications; the stents remain in position with no fracture. One patient underwent further successful dilation 3 years after stent implantation because of an exercise-induced gradient. No other intervention has been required. The systolic gradient at latest follow-up is 7 +/- 2 mm Hg. Only two (a 44-year old with diabetes and a 50-year old with long-standing hypertension) of five patients previously requiring antihypertensive treatment still remain on medications for blood pressure control.

Conclusions: The use of stents in COA is a feasible alternative to surgical repair or balloon angioplasty in selected patients with an effective gradient reduction. Intermediate-term follow-up shows excellent gradient relief, with no complications in this group of patients.

MeSH terms

  • Adolescent
  • Adult
  • Angioplasty, Balloon
  • Aortic Coarctation / diagnostic imaging
  • Aortic Coarctation / physiopathology
  • Aortic Coarctation / therapy*
  • Cardiac Catheterization
  • Female
  • Follow-Up Studies
  • Hemodynamics / physiology
  • Humans
  • Male
  • Middle Aged
  • Radiography
  • Stents*
  • Time Factors
  • Treatment Outcome