Immediate and follow-up findings after stent treatment for severe coarctation of aorta

Experimental studies have shown that stents implanted at the aorta become i ncorporated within the aortic wall and can be further expanded in growing a nimals. Few clinical studies have shown that the stent repair of severe coa rctation of aorta provides excellent initial results, and little is known o n the follow-up of these patients. We assessed the immediate and follow-up results obtained in a series of 48 patients (mean age 14 +/- 12 years) with severe coarctation of the aorta who were treated by Palmaz stent implantat ion; 30 of them (63%) underwent angiographic follow-vp studies at a mean of 25 +/- 11 months after treatment. Quantitative serial analysis of the aort ogram (baseline, after treatment, and at follow-up) was performed. Signific ant relief (mean residual gradient 3 +/- 4 mm Hg) was always obtained after scent implantation. The isthmus, when hypoplastic (60%), was always expand ed with the stent. One associated aneurysm became occluded after the implan t. Complications included aortic disruption, stent migration, and decreased or absent femoral pulses. At angiographic follow-up, the stent remained al ways in place, without recoil. in 22 patients (73%), there were no detectab le neointimal proliferation at late angiogram; however, 8 patients (27%) ha d some degree of intimal thickening (1 to 5 mm), causing mild restenosis in 3 patients treated at early age, and nonsignificant lumen reduction in 5. The serial aortogram analysis revealed a minor but, significant increase in nonstented aortic diameters that seemed related to the normal growth of ch ildren. No need for stent reexpansion was observed at 2-year follow-up (mea n). Two patients (7%) developed late small aneurysm formation at the stente d wall; both were occluded by the insertion of coils through the stent orif ices. We conclude that stent treatment for severe coarctation of aorta prov ides excellent immediate and long-term results in young adults and children . However, at early age, restenosis by intimal growth may develop. (C) 1999 by Excerpta Medica, Inc.