Self-Expanding Nitinol Stent Implantation for Treatment of Aortic Coarctation

Purpose: To prospectively assess the efficacy of self-expanding nitinol aortic stents in the treatment of coarctation of the aorta (CoA). Methods: Between July 2005 and July 2008, 21 patients (14 men; mean age 19.2 +/- 5.5 years, range 11-34) with CoA were treated with self-expanding Sinus-Aorta stents. The predilation balloon was selected to be <5 times the stenosis diameter. The stent diameter was selected to be 20% to 30% greater than the diameter of the undiseased aorta at the level of the diaphragm. Results:All procedures were successfully performed without any major complications. Predilation (mean balloon diameter 12.3 mm) and postdilation (mean balloon diameter 15.4 mm) were performed in 12 and 14 procedures, respectively. The mean diameter of the stents was 21.6 +/- 2.3 mm (range 18-26). The mean peak transcoarctation pressure gradient decreased from 57.4 +/- 19.5 mmHg (range 30-100) before the procedure to 1.2 +/- 2.2 mmHg (range 0-7; p<0.001). Cephalad stent dislodgement with the first-generation device occurred in 3 of 12 patients; 2 were treated with a second stent overlapping the first, and the third received 3 overlapped stents after the second stent migrated distally. No stent dislodgement occurred in the subsequent 9 patients treated with longer second-generation stents with anti-jump markers. None of the patients had dissection, arterial rupture, or other complications. On follow-up, 1 (5%) patient had recoarctation and minor stent migration after 18 months; another stent was deployed successfully. No evidence of aneurysm formation was seen in 7 patients undergoing arch imaging. Conclusion: CoA can be successfully and safely managed with self-expanding nitinol aortic stents without aortic wall complications. Stent malpositioning can be overcome using oversized stents with anti-jump markers. J Endovasc Ther. 2009;16:224-232