Endovascular stenting for unsuccessful angioplasty of the aorta in aortoarteritis

Purpose: The efficacy and safety of endovascular stent implantation to corr ect dissection or a suboptimal result after percutaneous transluminal angio plasty (PTA) was evaluated in patients suffering from aortic stenosis due t o aortoarteritis. Methods: Twelve children and young adults [aged (mean +/- SD) 18.2 +/- 8.7 years] underwent stent implantation after PTA of the aorta, seven for obstr uctive dissection, four for ineffective balloon dilatation, and one for rec urrent restenosis. Nine patients underwent implantation of self-expandable stents and three received balloon-expandable Palmaz stents. Results: Stent implantation could be successfully performed in all 12 patie nts. After stent implantation, the peak systolic pressure gradient decrease d from 91 +/- 33.5 mmHg to 12.4 +/- 12.5 mmHg (p < 0.001). The diameter of the stenosed segment increased from 4.6 +/- 0.8 mm to 11.1 +/- 1.9 mm (p < 0.001). The dissection was completely covered in all seven patients with di ssection. Except for epigastric pain with vomiting in one patient, there wa s no complication. On follow-up, over 12-57 months (mean 26.8 +/- 10.8 mont hs), 11 patients (91.6%) had marked improvement in their blood pressure. Pa tients with congestive heart failure and claudication also showed improveme nt. Repeat catheterization in five patients, between 6-30 months (mean 16.8 +/- 9.1 months) after stent implantation, showed sustained improvement in four and a fusiform, long segment, intrastent restenosis after 30 months in one child. The stenosis was safely redilated. Conclusion: Endovascular aortic stent implantation is safe and provides goo d immediate relief in patients with unsatisfactory results after balloon an gioplasty. Improvement is sustained in most patients on intermediate-term f ollow-up.