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Do we need to stent discrete (shelf-like) coarctation?
  1. ME Fawzy,
  2. A Fathala,
  3. H Al Sergani,
  4. M Kandeel,
  5. A Badr,
  6. B Dunn
  1. King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia

Abstract

Background and Objectives Although the immediate and intermediate-term results of balloon angioplasty for patients with aortic coarctation (AC) have been encouraging, there is paucity of data on long-term follow-up results. This study evaluated the long-term (up to 22 years) follow-up results of balloon angioplasty in adolescent and adult patients with discrete (shelf-like) AC and compare the findings with the reported results of stenting of AC.

Methods Follow-up data of 58 patients (mean age 24 ± 9 years) undergoing balloon angioplasty for discrete AC at median interval of 13.4 years (range 1–22 years) including cardiac catheterisation, magnetic resonance imaging and Doppler echocardiography form the basis of this study.

Results No early deaths occurred. Balloon angioplasty produced immediate reduction in peak AC gradient from 60 ± 22 mm Hg to 8.5 ± 8 mm Hg (p<0.0001). Follow-up catheterisation 12 months later revealed a residual gradient of 5 ± 6.4 mm Hg (p = 0.01). Five patients (8%) with suboptimal initial outcome (peak gradient >20 mm Hg) developed restenosis, and four of these had successful repeat angioplasty. Aneurysm developed at the site of dilatation in four patients (7%). Follow-up magnetic resonance imaging (up to 22 years) revealed no new aneurysm. In one patient, the aneurysm increased in size, but no recoarctation or appreciable changes in the Doppler gradient across the AC site was noted. The blood pressure had normalised without medical treatment in 29 (50%) of the 58 patients.

Conclusions Long-term results of balloon angioplasty for discrete AC are excellent and compare favourably with the reported results of stenting, accordingly stenting is not necessary for discrete AC.

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