Intermediate follow‐up following intravascular stenting for treatment of coarctation of the aorta

Catheterization and Cardiovascular Interventions - Tập 70 Số 4 - Trang 569-577 - 2007
Thomas J. Forbes1, Phillip Moore2, Carlos Augusto Cardoso Pedra3, Evan M. Zahn4, David Nykanen4, Zahid Amin5, Swati Garekar1, David Teitel2, Shakeel A. Qureshi6, John P. Cheatham7, Makram R. Ebeid8, Ziyad M. Hijazi9, Satinder K. Sandhu9, Donald J. Hagler10, Horst Sievert11, Thomas E. Fagan12, J. Ringwald13, Wei Du1, Liwen Tang1, David F. Wax14, John F. Rhodes15, Troy A. Johnston16, Thomas K. Jones16, Daniel R. Turner1, Robert H. Pass17, Alejandro Torres17, William E. Hellenbrand17
1Children's Hospital of Michigan, Wayne State University, Detroit, Michigan
2University of California at San Francisco, Division of Cardiology, San Francisco, California
3Instituto Dante Pazzanese de Cardiologia, Sao Paulo, SP, Brazil
4The Congenital Heart Institute at Miami, Children's Hospital and Arnold Palmer Women and Children's Hospital, Orlando, Florida
5Children's Hospital of Omaha, University of Nebraska Creighton University, Omaha, Nebraska
6Guy's Hospital, London, England
7Columbus Children’s Hospital, Ohio State University, Columbus, Ohio
8Children's Hospital of Mississippi, University of Mississippi/Jackson, Mississipi
9University of Chicago, Division of Cardiology, Chicago, Illinois
10Mayo Clinic, Rochester, Minnesota
11Cardiovascular Center Bethanien, Frankfurt, Germany
12Children's Hospital of Iowa, University of Iowa, Iowa City, Iowa
13Medical University of South Carolina, Division of Cardiology, Charleston, South Carolina
14Children's Memorial Hospital, Northwestern University, Lincoln Park, Illinois
15Duke Children's Heart Program, Duke University, Durham, North Carolina
16Seattle Children's Hospital, University of Washington, Seattle, Washington
17Babies and Children's Hospital of New York, Columbia Presbyterian, New York, New York

Tóm tắt

AbstractBackground: We report a multiinstitutional study on intermediate‐term outcome of intravascular stenting for treatment of coarctation of the aorta using integrated arch imaging (IAI) techniques. Methods and Results: Medical records of 578 patients from 17 institutions were reviewed. A total of 588 procedures were performed between May 1989 and Aug 2005. About 27% (160/588) procedures were followed up by further IAI of their aorta (MRI/CT/repeat cardiac catheterization) after initial stent procedures. Abnormal imaging studies included: the presence of dissection or aneurysm formation, stent fracture, or the presence of reobstruction within the stent (instent restenosis or significant intimal build‐up within the stent). Forty‐one abnormal imaging studies were reported in the intermediate follow‐up at median 12 months (0.5–92 months). Smaller postintervention of the aorta (CoA) diameter and an increased persistent systolic pressure gradient were associated with encountering abnormal follow‐up imaging studies. Aortic wall abnormalities included dissections (n = 5) and aneurysm (n = 13). The risk of encountering aortic wall abnormalities increased with larger percent increase in CoA diameter poststent implant, increasing balloon/coarc ratio, and performing prestent angioplasty. Stent restenosis was observed in 5/6 parts encountering stent fracture and neointimal buildup (n = 16). Small CoA diameter poststent implant and increased poststent residual pressure gradient increased the likelihood of encountering instent restenosis at intermediate follow‐up. Conclusions: Abnormalities were observed at intermediate follow‐up following IS placement for treatment of native and recurrent coarctation of the aorta. Not exceeding a balloon:coarctation ratio of 3.5 and avoidance of prestent angioplasty decreased the likelihood of encountering an abnormal follow‐up imaging study in patients undergoing intravascular stent placement for the treatment of coarctation of the aorta. We recommend IAI for all patients undergoing IS placement for treatment of CoA. © 2007 Wiley‐Liss, Inc.

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Catheterization and Cardiovascular Interventions

Tập 70 Số 4

569-577

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