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Endovascular aortic coarctation stenting in adolescents and adults: Angiographic and hemodynamic outcomes

Objectives: To assess the procedural, clinical, angiographic, and hemodynamic outcomes, including ambulatory blood pressure monitoring at 1 year in adolescent and adult patients undergoing primary stenting for treatment of aortic coarctation. Background: Stenting is widely used for treatment of aortic coarctation. Data regarding efficacy of this treatment for control of hypertension at 1 year is scant, with only one reported series of planned angiographic follow up. The impact of newer type stents for this procedure is also unknown. Methods: Thirty‐seven patients undergoing stenting for aortic coarctation, over a 3‐year period in a tertiary centre were studied as part of an observational protocol. Results: Peak gradient across the coarctation fell from 28.3 ± 15.1 to 3.7 ± 4.1 post procedure and was 11.9 ± 8.9 mmHg (P < 0.05 compared to baseline) at 1 year. There was one major complication (2.7%), with no deaths. Small aneurysms were seen in three patients (13%) on follow up angiography at 1 year. Right arm systolic blood pressures fell from 155 ± 19 to 132 ± 22 (P < 0.05) at 6 weeks and was 132 ± 16 mmHg (P < 0.05 compared to baseline) at 1 year. Ambulatory average systolic blood pressures fell from 142 ± 14 to 133 ± 15 at 6 weeks (P < 0.05) and to 125 ± 12 mmHg (P < 0.05 compared to baseline) at 1 year. No significant differences were seen in procedural outcomes between patients receiving Palmaz™ and CPNumed™ stents. Conclusion: Primary stenting of aortic coarctation in adolescents and adults results in excellent clinical and angiographic outcomes and sustained hemodynamic benefits at 1 year as evidenced by significant reduction in systolic blood pressure and gradients. Close follow up is required to monitor aneurysm formation. © 2006 Wiley‐Liss, Inc.