Coarctoplasty with self-expandable stent implantation for treatment of coarctation of aorta in adults.

BACKGROUND: Balloon angioplasty for treatment of coarctation of the aorta in adults, though promising, is sometimes limited by significant residual gradient (> 20 mmHg). Few studies have been reported on use of balloon-expandable stents in such a situation. We evaluated the use of self-expandable stents in patients with coarctation of the aorta.

METHODS: Eight hypertensive patients (age 15 to 27 years) with coarctation of the aorta (n = 6) or recoarctation (n = 2) and peak systolic gradient of > 40 mmHg underwent stent implantation. Balloon predilatation was done and self-expandable nitinol aortic stents (Optimed) were implanted in all patients.

RESULTS: The mean +/- SD peak systolic gradient decreased from a baseline of 55 +/- 15 (range: 40 - 75) to 5 +/- 2 (range: 3 - 7) mm Hg after angioplasty. Nitinol stents were easier to deploy and conformed better to aortic anatomy as compared with balloon-expandable stents. The mean +/- SD diameter of the coarcted segment increased from 3 +/- 1 mm to 16 +/- 2 mm. There were no complications in our series. On 6- to 9-month follow-up, all the implanted stents remained in their original positions and none showed evidence of fracture. Significant improvement in hypertension was seen in 7 out of 8 patients.

CONCLUSION: Stent implantation is safe and effective in treating coarctation of the aorta. Self-expandable stents were easy to implant, had good adaptation to the wall of the aorta, and in most patients had similar efficacy in reducing coarctation of the aorta as surgical repair.