Benefit of endovascular stenting for aortic coarctation on systemic hypertension in adults

Background. - Endovascular stenting is a recognised treatment strategy for aortic coarctation (CoA) in adults. We assessed systemic hypertension control and the need for antihypertensive therapy after CoA stenting in adults. Methods. - Data were collected prospectively on 54 patients (36 men; mean age: 34 +/- 16 years) who underwent endovascular stenting for CoA over a 7-year period. Five patients were excluded as they did not attend follow-up appointments. Patients underwent clinical examination, including right arm systolic blood pressure (SBP) and 24-hour ambulatory blood pressure monitoring at baseline, 6-12 weeks and 9-12 months. Results. - There was a significant fall in mean peak-to-peak systolic gradient (PG) across the CoA after stenting (26 +/- 11 mmHg vs. 5 +/- 4 mmHg; P < 0.01). There were successive reductions in right arm SBP and ambulatory SBP at baseline, 6-12 weeks and 9-12 months post-procedure (right arm: 155 +/- 18 mmHg vs. 137 +/- 17 mmHg vs. 142 +/- 16 mmHg, respectively; all P-values <0.01; ambulatory: 142 +/- 14 mmHg vs. 132 +/- 16 mmHg vs. 131 +/- 15 mmHg, respectively; all P-values <0.01). Twenty-four patients had severe CoA (PG > 25 mmHg before stenting); baseline SBP was significantly higher in severe versus non-severe patients (160 mmHg vs. 148 mmHg; P=0.02). The absolute reduction in PG after stenting was significantly higher in the severe group (31 +/- 7 mmHg vs. 14 +/- 5 mmHg; P < 0.0001), but there was no significant difference in SBP between groups at 6-12 weeks (141 mmHg vs. 135 mmHg; P = 0.21) or 9-12 months (139 mmHg vs. 139 mmHg; P = 0.96). Conclusion. - Endovascular stenting of CoA results in a significant reduction in SBP at 6-12 weeks, which is sustained at 9-12 months, with similar outcomes in severe and non-severe CoA groups. (C) 2015 Elsevier Masson SAS. All rights reserved.