From bare to covered: 15-year single center experience and follow-up in trans-catheter stent implantation for aortic coarctation

Catheter Cardiovasc Interv. 2014 May 1;83(6):953-63. doi: 10.1002/ccd.25404. Epub 2014 Feb 4.

Abstract

Background: Bare stents has become the first line therapy for aortic coarctation. Covered stents has been reported more recently in clinical practice.

Objectives: The present study, reports comparatively 15-year experience of bare and covered stent implantation for aortic coarctation in a single tertiary referral center.

Methods: From 1997 to 2011, 143 patients with native or postoperative aortic coarctation were treated at our institution. Seventy-one subjects (median age 17 years (range from 4 to 70 years) underwent bare stent implantation (Group 1) while 72 patients (median age of 17.5 years (range from 6 to 68 years) underwent covered stent implantation (Group 2).

Results: Success rate in the whole group was 95%. More complex and tighter coarctations were treated using covered stents. Incidence of related-procedure adverse events was higher in Group 1 than in group 2 (21.1% vs. 8.3% P = 0.035). Aortic wall complications occurred in 7% of patients in Group 1 (one death) and 0% in Group 2 (P = 0.028). Subjects in Group 1 had a longer follow-up (median 85 vs. 35 months; P < 0.001). Independent predictors associated with reintervention included the presence of complex lesions (HR: 2.70; CI: 1.15-6.32), balloon diameter used <14 mm (HR: 3.76; CI: 1.48-9.55), and immediate residual gradient >10 mm Hg (HR: 4.30; CI: 1.96-9.47).

Conclusions: Both bare and covered stent implantation for aortic coarctation is a safe and efficacious treatment. By using covered stent implantation the spectrum of patients treated has increased with lower rates of acute and late complications.

Keywords: aortic coarctation; stent; transcatheter; treatment.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aortic Coarctation / diagnosis
  • Aortic Coarctation / therapy*
  • Aortography
  • Child
  • Child, Preschool
  • Endovascular Procedures / adverse effects
  • Endovascular Procedures / instrumentation*
  • Female
  • Humans
  • Italy
  • Male
  • Middle Aged
  • Prosthesis Design
  • Retreatment
  • Retrospective Studies
  • Risk Factors
  • Stents*
  • Tertiary Care Centers
  • Time Factors
  • Treatment Outcome
  • Young Adult