Aortic coarctation complicated by wall aneurysm: The role of covered stents

Gianfranco Butera, Mohamed Heles, Simon T. MacDonald, Mario Carminati

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: To evaluate the management of aneurysms associated with aortic coarctation by covered stent deployment. Background: Aortic aneurysm formation complicating aortic coarctation carries a risk of rupture with high mortality rate. Surgical repair has a significant mortality and may be associated with central nervous system injury, including paraplegia. Transcatheter intervention alternatively carries a risk of aneurysmal rupture. Methods: Between July 2004 and September 2009, 140 consecutive patients underwent percutaneous stent implantation to treat aortic coarctation. Eleven (7.9%) patients had coarctation associated with aortic wall aneurysm: three with native coarctation with wall aneurysm, three with previous surgical coarctation repair, three with previous balloon angioplasty, and two with previous bare stent implantation. The e-PTFE-covered 8Zig Cheatham-Platinum stents were used to treat all 11 patients. Results: Median age at procedure was 13 years (range, 6-66 years). Successful device deployment was achieved in all patients. Systolic pressure gradient reduced significantly from a median baseline of 30 mm Hg (range, 25-50 mm Hg) to a postprocedural median of 5 mm Hg (range, 0-20 mm Hg) (P <0.01). Aortic diameter increased from a median value of 6 mm (range, 0.5-11 mm) to a median value of 12 mm (range, 10-22 mm) (P <0.001). No early complications occurred, with successful relief of stenoses and complete sealing of all aneurysms. Median follow-up was 50 months (range, 16-61 months). Redilatation was required in four patients (one patient with intrastent restenosis secondary to significant endothelial growth, whereas the other three patients showed restenosis secondary to somatic growth). Redilatation with a larger balloon was performed without complication in all cases. Conclusions: Our data show that covered stents are a safe and effective treatment with low risk of complications for the treatment of coarctation associated with aortic wall aneurysm.

Original languageEnglish
Pages (from-to)926-932
Number of pages7
JournalCatheterization and Cardiovascular Interventions
Volume78
Issue number6
DOIs
Publication statusPublished - Nov 15 2011

Keywords

  • aneurysm
  • aorta
  • coarctation
  • covered stents

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

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