Endovascular stents for coarctation of the aorta: Initial results and intermediate-term follow-up

OBJECTIVES The aim of this study was to evaluate the use of endovascular st ents in native and recurrent coarctation of the aorta (CoA). BACKGROUND Stents have been used successfully in various locations. Their u se in CoA can be an alternative to surgery or balloon angioplasty (BA). METHODS Thirty-four patients with CoA (13 native and 21 re-coarctation afte r surgery or BA) with a mean age of 16 +/- 8 years (range 4 to 36 years) un derwent attempted stent implantation between 1993 and 1999. Successful outc ome was defined as peak systolic pressure gradient after stent implantation <20 mm Hg. RESULTS Stents were implanted in 33/34 patients, and successful outcome occ urred in 32/33 patients. Peak systolic pressure gradient decreased from 32 +/- 12 mm Hg to 4 +/- 11 mm. Hg (p < 0.001). Coarctation site to descending aorta diameter ratio increased from 0.46 +/- 0.16 to 0.92 +/- 0.16 (p < 0. 001). Two patients underwent successful stent re-dilation 16 and 21 months after initial implantation. Six patients (18%) developed complications, inc luding two patients who underwent surgery. Follow-up for 29 +/- 17 months ( range: 5 to 81 months) demonstrated no evidence of re-coarctation, aneurysm formation, stent displacement or fracture. Systolic blood pressure (SBP) d ecreased from 136 +/- 21 mm Hg before stent placement to 122 +/- 19 mm Hg a t follow-up (p = 0.002). The SBP gradient decreased from 39 +/- 18 mm. Hg t o 4 +/-6 mm Hg, and peak Doppler gradient decreased from 51 +/- 26 mm. Hg t o 13 +/- 11 mm Hg at follow-up (p < 0.001). CONCLUSIONS Intravascular stent placement for native and recurrent CoA has excellent results in the short and intermediate terms. Long-term outcome re mains to be evaluated. (J Am Coll Cardiol 2001;38:1518-23) (C) 2001 by the American College of Cardiology.