Revista argentina de cardiología
versión On-line ISSN 1850-3748
ALONSO, José; SCIEGATA, Alberto; JMELNITSKY, Luis y FAELLA, Horacio. Stenting Aortic Coarctation and Recoarctation: Immediate Results, Short and Mid-term Follow-up. Rev. argent. cardiol. [online]. 2005, vol.73, n.5, pp. 336-340. ISSN 1850-3748.
The use of stents for the treatment of aortic coarctation and recoarctation is a recently developed therapeutic modality. We would like to communicate our immediate results, complications and mid term follow-up. During a 7 year period, we performed stent angioplasty in 47 patients with a diagnosis of aortic coarctation, 37 of which were native and 10 were re-coactations. Patients' mean age was 13 (6 to 37) years and mean weight was 46 (24 to 75) Kg. All procedures were performed percutaneously through the femoral artery and performed under general anesthesia. Fifty-one stents were implanted; conventional catheter balloons in 21 patients and balloon in balloon catheters (BIB) in the remaining 26. Thirty one Palmaz stents were implanted (17 P4014, 10 P308, 5 P5014) and 20 CP stents (8 zigs x 39 mm: 11.8 zigs × 34 mm: 6.8 zigs × 55 mm: 1.8 zigs × 28 mm : 1 and 8 zigs × 22 mm: Four of them were covered CP stent. Gradient reduction from a mean of 33±17 mmHg (10-84 mmHg) to 0±5.16 mmHg (0-30 mmHg) (p< 0.001) and an increase in diameter at the coarctation site from x: 5.5±2.7 mm (1.7-12.2 mm) to x: 15±3.2 mm (5.2-18.3 mm) (p< 0.001) was achieved. There were 3 major complications, 2 cerebrovascular accidents and 1 rupture of the femoral artery which needed surgical repair and 8 minor complications: 2 bleedings at the access site, 3 transient systemic hypertension, 2 diminished pulse and 1 transient cerebrovascular accident with full recovery. We had 2 conventional balloon ruptures. Three patients had wrong positioning of the stent, 2 of them underwent a second stenting in proper position, one of them currently under follow-up. Another 2 had late distal migration and underwent a new procedure with correct stenting. All the balloon ruptures and wrong positioning occurred with conventional balloons. During the mid-term follow up, between 1 month and 6.8 years (mean 3.8 years), we lost track of 15 patients and the rest were evaluated clinically, by X-rays, echocardiographically, by pressurometry and in selected patients by means of CT scan. Two patients were re-dilated and another 2 are waiting for a new angioplasty with high pressure balloons. Nine patients had previous antihypertensive treatment, which could be discontinued in 5. We conclude that stenting in native and postsurgical coarctation of the aorta is an effective and safe procedure. The morbidity of the method is progressively diminishing with the development of better and new specific materials, like BIB balloons and CP stents. The learning curve is also a very important issue.
Palabras llave : Aortic Coarctation; Stents; Angioplasty.