Abstract 2449: Procedural results and Acute Complications in Stenting Native and Recurrent Coarctation of the Aorta: A Multi-Institutional Study
Background: We report a multi-institutional experience with intravascular stenting for treatment of coarctation of the aorta.
Methods and Results: Medical records from 17 institutions were reviewed. A total of 588 procedures were performed at a median age 15 years (mean = 18.1 years). Successful reduction in the post stenting gradient (< 20mmHg) or increase in post stent coarctation to descending aorta ratio of >0.8 was achieved in 98.6% of procedures. There was significant (p< 0.01) improvement in pre versus post stent coarctation segment dimensions (7.2 ± 3.1 mm versus 14.0 ± 3.5mm), systolic gradient (32.0 ± 16.2 mmHg versus 3.4 ± 6.0 mmHg) and ratio of the coarctation segment to the descending aorta (0.43 ± 0.17 versus 0.85 ± 0.16). Acute complications were encountered in 69/588 (11.7%) procedures, with some procedures accounting for more than one complication, making the total of 84 complications observed. There were two procedure related deaths. Aortic wall complications included: aneurysm formation (n=6), intimal tears (n=8), and dissections (n=9). The risk of aortic dissection significantly increased in patients over the age of 20 years. Technical complications included stent migration (n=28) and balloon rupture (n=13). Peripheral vascular complications included cerebral vascular accidents (n=4), peripheral emboli (n=1) and significant access arterial injury (n=15). Older age was significantly associated with occurrence of cerebral vascular accidents.
Conclusions: Stent placement for coarctation of aorta is an effective treatment option, though remains a technically challenging procedure. Technical and aortic complications will likely decrease with improvement in balloon and stent design, though improvement in our ability to assess aortic wall compliance is essential prior to placement of intravascular stents in older pts with coarctation of the aorta.