Middle aortic syndrome treated by stent implantation

Objectives-To determine outcome of stent implantation in patients with midd le aortic syndrome. Design-Prospective study, case series. Setting-A tertiary paediatric cardiology centre in a children's hospital. Patients-Five patients, aged 4 to 17 years (mean 11.4 years), with upper li mb hyper-tension due to middle aortic syndrome. Intervention-Stents were implanted in the mid/lower thoracic/upper abdomina l aorta. Main outcome measure-Satisfactory deployment of stents and blood pressure c ontrol. Results-In all patients, angiocardiography showed long segment stenosis in the mid or lower thoracic/upper abdominal aorta. The pressure gradient was between 40 and 90 mm Hg (mean 63.2 mm Hg). Seven Palmaz stents were implant ed. Immediately after implantation, the gradient decreased to between 0 and 35 mm Hg (mean 13.6 mm Hg). Angiography showed a satisfactory result with widely patent stents in all. In one patient, thrombosis of the stent occurr ed six days after implantation. This was successfully treated with infusion of alteplase, further balloon dilatation, and implantation of a second ste nt overlapping the first, both dilated to 10 mm diameter. One patient had e lective redilatation of the stent six months after implantation, with furth er reduction of the gradient from 35 mm Hg to 10 mm Hg. At the latest follo w up between three and 20 months (mean 12.2 Methods months) after stent imp lantation, in four PATIENTS patients blood pressure was better controlled t rolled with antihypertensive drugs. One patient was normotensive without dr ugs. Computed tomography showed no aneurysm formation in the region of the stents. Conclusions-Stent implantation is a preferable alternative to surgery in th e treatment of patients with middle aortic syndrome and merits further eval uation.