Covered Stents in Patients With Complex Aortic Coarctations

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´╗┐Covered Stents in Patients With Complex Aortic Coarctations

Abstract and Introduction

Abstract


Background: There are limited data in the literature about the use of covered stent in patients with aortic coarctation.
Methods: Between January 2004 and September 2006, we implanted covered Cheatham-Platinum stents in 33 patients with complex aortic coarctation (23 men, median age 13 years, range 6-66 years). Twenty subjects had native aortic coarctation, whereas 13 had recoarctation. All procedures were performed under general anesthesia and orotracheal intubation.
Results: The stents used ranged from 22 to 45 mm in length. The mean fluoroscopy and procedure times were 14 ┬▒ 6 and 74 ┬▒ 15 minutes, respectively. After implantation, the gradient across the stenosis decreased significantly (pre stent: median value 39 mm Hg [range 20-75 mm Hg] vs post stent: median value 0 mm Hg [range 0-12 mm Hg] [P < .0001]). Vessel diameter increased from a median value of 5 mm (range 0-11) to a median value of 15 mm (range 10-25) (P < .0001). The stents were placed in the correct position in all subjects. No complications occurred, and on angiographic control, the stenoses had been relieved and the aneurysms completely excluded. During a median follow-up of 12 months (1-40 months), the results were stable without complications. One patient developed intrastent restenosis due to a significant endothelial proliferation that was successfully treated by high-pressure balloon angioplasty.
Conclusions: Covered Cheatham-Platinum stents are promising tools for the treatment of complex aortic coarctation.

Introduction


Surgery or standard transcatheter approaches (balloon angioplasty or bare stent implantation) can be associated with significant morbidity and mortality in patients with complex aortic coarctations (ie, subatretic aortic coarctation or associated with aneurysm). Bare stents have been used in all sites in patients with congenital heart diseases, and large series and follow-up studies are reported in literature. However, even with these stents, aneurysms may form, or aortic rupture may occur.

Covered stents are currently widely used in the treatment of abdominal and thoracic atherosclerotic aneurysm in adults. However, there is limited experience on the use of covered stents in congenital heart diseases, a setting in which their role remains to be clearly defined.

In the present study, we report our experience of 33 patients in whom covered Cheatham-Platinum (CP) stents were used for the treatment of complex aortic coarctation.

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