Stents in the Management of Coarctation of the Aorta in Adolescent and Adult — Experience from a Developing Country

Abstract

In our setup, a significant number of older children, adolescents and adults are diagnosed as having coarctation of aorta (CoA) as diagnosis is often missed in early life. The traditional approach to such patients has been surgery and various techniques have been used to resect or patch it. Balloon dilation for CoA has been limited by concerns over the risk for acute dissection, late restenosis, or aneurysm. The objective of this study was to assess the early and mid- term results of stenting as primary treatment in older children, adolescents and adults with coarctation of the aorta Punjab Institute of Cardiology-a tertiary referral center for paediatric & adult cardiology. All patients seen with coarctation of the aorta between October 1999 and September 2002 and considered suitable for stent implantation underwent attempted stent implantation. Follow up was obtained for all patients and a subgroup (n = 4) had spiral CT scan at mean (SD) of 1.3(0.5) years to assess residual gradient and stent-CoA morphology. We implanted Cheatham Platinum (CP) stents from NuMED with BIB balloon in 18 adolescents and adults with native coarctation of the aorta. All procedures were done under general anaesthesia. There were 10 males and 8 females, two of them real sisters. The median age was 24 years (range 12-40 yrs). The indication of intervention was systemic hypertension in all pts Stents were placed in 17 patients, of whom one had a prior balloon dilation Hypertension was present in all patients (mean pressure 74 (26)/90(13) mm Hg), of whom 16 were on antihypertension drugs. CoA gradients were 50 (20) mmHg (range 38—106mm Hg) at baseline and 3 (5) mm Hg after the procedure. One patient had an unsuccessful procedure as the stent foreshortened significantly at full inflation and slipped from the site of coarctation. It was expanded lower down in aorta One underwent a second procedure as stent was not fully inflated first time due to severe hypoplasia of coarctation segment. At 1.8 (1) years after the procedure the mean pressure was 136 (14)174 (ii) mm 11g with seven patients on antihypertension treatment. None of the 16 patients where complete relief was achieved at first attempt has shown recoarctation on echocardiography. No adverse systemic hypertension has been noticed. Stent implantation in coarctation of aorta in elder children, adolescents and adults is an attractive alternative to surgery. Use of CP stents with BIB balloon allows a better control over site of placement and better stability. It achieves complete relief of obstruction with minimal complications and good intermediate term results.