Procedural results and acute complications in stenting native and recurrent coarctation of the aorta in patients over 4 years of age: A multi-institutional study

作者：Forbes Thomas J^*; Garekar Swati; Amin Zahid; Zahn Evan M; Nykanen David; Moore Phillip; Qureshi Shakeel A; Cheatham John P; Ebeid Makram R; Hijazi Ziyad M; Sandhu Satinder; Hagler Donald J; Sievert Horst; Fagan Thomas E; Ringewald Jeremy; Du Wei; Tang Liwen; Wax David F; Rhodes John; Johnston Troy A; Jones Thomas K; Turner Daniel R; Pedra Carlos A C; Hellenbrand William E

来源：Catheterization and Cardiovascular Interventions, 2007, 70(2): 276-285.

DOI：10.1002/ccd.21164

• coarctation
• intravascular stent, complications

Background: We report a multi-institutional experience with intravascular stenting (IS) for treatment of coarctation of the aorta. Methods and Results: Data was collected retrospectively by review of medical records from 17 institutions. The data was broken down to prior to 2002 and after 2002 for further analysis. A total of 565 procedures were performed with a median age of 15 years (mean = 18.1 years). Successful reduction in the post stent gradient (< 20 mm Hg) or increase in post stent coarctation to descending aorta (DAo) ratio of > 0.8 was achieved in 97.9% of procedures. There was significant improvement (P < 0.01) in pre versus post stent coarctation dimensions (7.4 mm +/- 3.0 mm vs. 14.3 +/- 3.2mm), systolic gradient (31.6 mim Hg +/- 16.0 mm Hg vs. 2.7 mm Hg +/- 4.2 mm Hg) and ratio of the coarctation segment to the DAo (0.43 +/- 0.17 vs. 0.85 +/- 0.15). Acute complications were encountered in 81/565 (14.3%) procedures. 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 increased significantly in patients over the age of 40 years. Technical complications included stent migration (n = 28), and balloon rupture (n = 13). Peripheral vascular complications included cerebral vascular accidents (CVA) (n = 4), peripheral emboli (n = 1), and significant access arterial injury (n = 13). Older age was significantly associated with occurrence of CVAs. A significant decrease in the technical complication rate from 16.3% to 6.1% (P < 0.001) was observed in procedures performed after January 2002. Conclusions: Stent placement for coarctation of aorta is an effective treatment option, though it remains a technically challenging procedure. Technical and aortic complications have decreased over the past 3 years due to, in part, improvement in balloon and stent design. Improvement in our ability to assess aortic wall compliance is essential prior to placement of ISs in older patients with coarctation of the aorta.

• 出版日期2007-8-1
• 单位西北大学