Balloon angioplasty with stent implantation in recoarctation of the aorta:An attractive option.

The results of transcatheter balloon angioplasty in teenagers and adults wi th aortic recoarctation are uncertain. Therefore, there is a current trend to prefer a more complex procedure including the implantation of a stent. This study deals with 8 patients aged 7 to 25.3 years (median: 15 years), w eighing 20 to 68 kg. (median: 57) and having undergone resection of an aort ic coarctation during infancy (24 days to 4 years). All had their lower lim b pulses diminished or abolished, elevated blood pressure at rest (and at e xercise in the 5 tested patients), and left ventricular hypertrophy. MRI do cumented the lesion and helped to select seven patients whose stenosis was short and remote enough from the origin of the main aortic collateral. In o ne case, the decision to stent was taken as an emergent measure to treat an aortic dissection which appeared shortly after balloon dilatation. The eff ectiveness of the procedure was immediate in all patients with a 50% increa se in diameter of the dilated area, total relief of the gradient, drop to n ormal values of the blood pressure. These good results persisted at follow- up (3-24 months) in 6 patients, with moderate hypertensive rebounds in the last 2. There were 2 technical problems (premature burst of the balloon, asymmetric al inflation of the stent like an "Eiffel Tower") that could finally be ove rcome and should no longer occur with the new specially designed so-called "BIB" balloons. Would long term follow-up confirm these early results, one should conclude that this method offers an attractive, safe and effective o ption to surgery for adolescents and adults with late recoarctation of the aorta.