Covered stents in the management of coarctation of the aorta in the adult: Initial results and 1-year angiographic and hemodynamic follow-up

Background: The purpose of this study was to determine the safety and efficacy of the Cheatham Platinum covered stent in adults with coarctation of the aorta. Methods: Adults with native coarctations (n=14); previous coarctation surgery (n=4), stenting (n=1) or both surgery and endovascular therapy (n=3) underwent percutaneous intervention with a covered stent. Indications for stenting in those with previous intervention were recurrent coarctation (n=4), aneurysm formation at the site of previous intervention (n=2) or both recurrent coarctation and aneurysm formation (n=2). Results: Twenty-three covered stents were placed in 22 patients (mean age 39 +/- 14 years, n=11 males). Successful device deployment was achieved in all patients, although one patient required a second covered stent for aortic wall rupture. Peak systolic gradient across the coarctation site decreased from 29 +/- 17 to 3 +/- 5 mm Hg (p<0.001) immediately following implant and this was maintained (6 +/- 9 mm Hg, p=0.001) at invasive assessment, 12 months after the initial procedure. Right arm systolic blood pressure significantly declined (p=0.02), as did the number of antihypertensive medications per patient (p=0.03). At angiographic follow-up, post-stenotic dilatation of the aorta decreased from 32 +/- 8 mm to 30 +/- 8 mm (p=0.001), however, no stent recoil was observed. Conclusions: Covered stents are safe, durable and efficacious in the management of coarctation of the aorta. Angiography and hemodynamic assessment is an effective method of screening for recurrent coarctation, and arch and vascular complications after stenting in adults. (C) 2009 Elsevier Ireland Ltd. All rights reserved.