Korean Circ J.  2017 Jan;47(1):97-106. 10.4070/kcj.2016.0211.

Early and Midterm Results Following Interventional Coarctoplasty: Evaluation of Variables that Can Affect the Results

• Bassiri HA
• Abdi S
• Shafe O
• Sarpooshi

• KMID: 2365288
• DOI: http://doi.org/10.4070/kcj.2016.0211

Abstract

BACKGROUND AND OBJECTIVES
Stent coarctoplasty has been approved as the treatment of choice for adult patients with coarctation of the aorta. We have evaluated the early and midterm clinical and procedural results after interventional coarctoplasty. Also, variables that can affect these results were evaluated.
SUBJECTS AND METHODS
Gathering clinical, angiographic and procedural data, we evaluated the pre-specified outcomes, including procedural success, complications, the incidence of hypertension after coarctoplasty etc., after the procedure. The effect of pre-specified variables including aortic arch shape, coarctation type and etc. on the procedural result was evaluated.
RESULTS
Between February 2005 through March 2014, 133 stent coarctoplasty procedures were performed. Median age was 23.5 years old (interquartile range [IQR]:19-28), and 105 (71.9%) were male. Nearly all of the patients were undergone stent coarctoplasty, mostly with cheatham platinum (CP) stents. There was no association between aortic arch morphology and acute procedural complications. Balloon length more than 40 mm (p=0.028), aorta diameter at the site of Coarctation larger than 2.35 mm (p=0.008) was associated with higher rate of restenosis during follow-up. Comparison between the prevalence of hypertension (HTN) before and after coarctoplasty showed a significant reduction in the prevalence of HTN (117 [91.4%] vs. 95 [74.2%] p<0.001).
CONCLUSION
Stent coarctoplasty is a low-risk procedure with favorable early and delayed outcomes. Most mortality is related to the patient's comorbid conditions and not to the procedure.

Keyword

Aortic coarctation; Stents; Aorta, thoracic

MeSH Terms

Adult
Aorta
Aorta, Thoracic
Aortic Coarctation
Follow-Up Studies
Humans
Hypertension
Incidence
Male
Mortality
Platinum
Prevalence
Stents
Platinum

Figure

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  Fig. 1 Anatomical variants of the aortic arch. (A) The width and height of arch are nearly equal; it is typical for Circular arch. (B) The width is shorter than height in the typical Gothic arch. (C) Crenel arch is defined by shorter height than width. The picture beneath description of juxta and postductal coarctation. The distance between SCA origin to the coarctation site narrowing is the reference for such definition. In this case, the length is about 16 mm, which is categorized as postductal. Note the presence of localized dissection at the coarctation site with involvement of SCA origin and arch. The dissection occurred during wiring of coarctation. The covered stent was used for this patient because of dissection. SCA: subclavian artery.

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  Fig. 2 Stent coarctoplasty. (A) Injection of the contrast media at descending aorta after passing the pigtail catheter over a 0.035 inch-wire. (B) Positioning of the stent. (C) Stent deployment during rapid pacing. (D) Final result.

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  Fig. 3 Management of a patient with aortic perforation after stent deployment. (A, B) After the stent was deployed at the site of this postductal coarctation, contrast injection revealed a tiny but important contrast leakage at the distal edge of the stent. (C) A CP 38 covered stent deployed to cover the perforation site, but the leakage persisted. (D, E) Post dilation causes the leakage to stop. CP: cheatham platinum.

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  Fig. 4 Reduction in blood pressure and antihypertensive drugs number pattern after treatment of the coarctation of the aorta. (A) Systolic BP and (B) number of drugs were used for treating HTN, just after coarctoplasty and at the end of follow-up. CI: confidence interval, BP: blood pressure, HTN: hypertension.

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