Abstract 1933: Medium Term Results of Coarctation Stent Angioplasty with Detailed Computerised Tomography Follow Up
Objective:To evaluate medium term outcome after coarctation stent angioplasty.
Methods: Retrospective study. Coarctation stent angioplasty procedures were identified from the departmental database.
Results: 50 procedures in 43 patients (25 females) performed between August 2002 and May 2006. 24 patients had native coarctation; 20 had previous arch surgery. 6 procedures were repeat balloon angioplasty procedures on previously implanted stents. Median age of the patients was 17.9 (range 8–60) years and weight 64 (range 31.5–96) kg. 31 patients had associated structural heart disease. 31 patients had systemic hypertension; 2 had aneurysm near the coarctation site prior to angioplasty. The median procedure time was 78 minutes (range 30–149) and screening time 10.5 minutes (range 3–25). Sixteen Genesis stents were implanted; others included Palmaz (n = 9) and Cheatham Platinum ( n = 20) stents. The mean gradient pre procedure was 23.4 mm Hg; this reduced to mean 4.9 mm Hg post procedure. In 3 patients with tight native coarctation, the stent was deliberately under dilated on the first occasion. 4 other patients had residual coarctation needing repeat balloon angioplasty with a high pressure balloon. In 1 patient, angioplasty was done with covered stent to treat aortic aneurysm associated with previous coarctation surgery , rather than recoarctation. Covered stents were used in 3 patients , when the arch anatomy suggested a higher risk for dissection. CT scans of the aorta were performed generally 4 – 6 months after treatment. The median follow up was 24.3 months (range 0 – 40). CT evaluation of the stented area is availailable for 37/50 procedures. There was no new aneurysm in the follow up period. Stent fractures were seen in 5 patients( all Genesis stents). One fracture occurred at repeat angioplasty, the others during follow up. There have been no adverse events associated with stent fracture and no additional treatment has been required so far.
Conclusions: Stent angioplasty for coarctation of the aorta produces good medium term relief of obstruction with no aneurysm development. Incidental stent fracture is seen with Genesis stents but so far have not been associated with functional problems. CT Scan follow up evaluation is important for this group of patients.