Title: Procedural Outcome and Short Term Follow Up of Patients Undergoing Endovascular Stenting for Coarctation of Aorta: A Single Centre Experience
Authors: Dr Lakshmi Sadasivan Pillai, Dr Kothandam Sivakumar
DOI: https://dx.doi.org/10.18535/jmscr/v5i5.185
Abstract
Background: Endovascular stenting is the preferred option in managing coarctation of aorta (COA) in older children and adults. Covered stents are used in selected or high risk category of patients. We present our experience with stenting of coarctation of aorta.
Materials and Methods: Patients with severe coarctation of aorta who underwent endovascular stenting during the period July 2013 to July 2016 were retrospectively analysed. CT aortogram was used for pre procedural imaging. Procedural outcome complications and short term follow up were noted.
Results: 22 patients (seven females) aged 1-52 years (median 29), weighing 7.8 -86.4 (median 55.1) kg, underwent stenting of COA. All except one had post subclavian coarctation. 68.2% of patients had hypertension and were on treatment. Mean gradient at catheterisation was 71.7 ± 28.6 mm hg and mean gradient post procedure was 3.6 ± 4.4 mmhg. A total of 22 stents were deployed, Covered CP (12), Cook Formula (1), Advanta V12 Atrium (2), Intrastent Mega(3), Palmaz (2), Andrastent.(1),Bare CP (1). Covered stents were used in 59.1%.The mean stent length was 35 ± 12.5 mm. Pre dilatation was done in two patients including one with near interruption. Post dilatation was needed in 36.4% of patients. Procedural complications included retroperitoneal hemorrhage in one which resulted in mortality. Follow-up ranged from 1 month to 3.5 years. 36.4% required continuation of antihypertensive therapy even after stenting. One patient with presubclavian coarctation required redilatation 6 months after stenting.
Conclusions: Stent implantation is a safe and effective alternative to surgical repair in COA. It provides immediate and near complete relief of obstruction which is sustained on short term follow up. Long term follow up is required to look for restenosis, aneurysm formation and persistent systemic hypertension.
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