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

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

Research output: Contribution to journalArticle

168 Citations (Scopus)

Abstract

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 mm 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.

Original languageEnglish
Pages (from-to)276-285
Number of pages10
JournalCatheterization and Cardiovascular Interventions
Volume70
Issue number2
DOIs
StatePublished - Aug 1 2007
Externally publishedYes

Fingerprint

Aortic Coarctation
Stents
Blood Vessels
Dissection
Tunica Intima
Embolism
Compliance
Accidents
Medical Records
Aneurysm
Rupture
Wounds and Injuries
Therapeutics

Keywords

  • Coarctation
  • Complications
  • Intravascular stent

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

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. / 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 K; 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.

In: Catheterization and Cardiovascular Interventions, Vol. 70, No. 2, 01.08.2007, p. 276-285.

Research output: Contribution to journalArticle

Forbes, TJ, Garekar, S, Amin, Z, Zahn, EM, Nykanen, D, Moore, P, Qureshi, SA, Cheatham, JP, Ebeid, MR, Hijazi, ZM, Sandhu, SK, Hagler, DJ, Sievert, H, Fagan, TE, Ringewald, J, Du, W, Tang, L, Wax, DF, Rhodes, J, Johnston, TA, Jones, TK, Turner, DR, Pedra, CAC & Hellenbrand, WE 2007, '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', Catheterization and Cardiovascular Interventions, vol. 70, no. 2, pp. 276-285. https://doi.org/10.1002/ccd.21164
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 K ; 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. / 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. In: Catheterization and Cardiovascular Interventions. 2007 ; Vol. 70, No. 2. pp. 276-285.
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T1 - Procedural results and acute complications in stenting native and recurrent coarctation of the aorta in patients over 4 years of age

T2 - A multi-institutional study

AU - Forbes, Thomas J.

AU - Garekar, Swati

AU - Amin, Zahid

AU - Zahn, Evan M.

AU - Nykanen, David

AU - Moore, Phillip

AU - Qureshi, Shakeel A.

AU - Cheatham, John P.

AU - Ebeid, Makram R.

AU - Hijazi, Ziyad M.

AU - Sandhu, Satinder K

AU - Hagler, Donald J.

AU - Sievert, Horst

AU - Fagan, Thomas E.

AU - Ringewald, Jeremy

AU - Du, Wei

AU - Tang, Liwen

AU - Wax, David F.

AU - Rhodes, John

AU - Johnston, Troy A.

AU - Jones, Thomas K.

AU - Turner, Daniel R.

AU - Pedra, Carlos A C

AU - Hellenbrand, William E.

PY - 2007/8/1

Y1 - 2007/8/1

N2 - 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 mm 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.

AB - 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 mm 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.

KW - Coarctation

KW - Complications

KW - Intravascular stent

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