Article Text

Download PDFPDF

The efficacy and safety of stent redilatation in congenital heart disease
  1. C Duke,
  2. E Rosenthal,
  3. S A Qureshi
  1. Department of Paediatric Cardiology, Guy’s Hospital, London, UK
  1. Correspondence to:
    Dr S A Qureshi, Department of Paediatric Cardiology, 11th Floor Guy’s Tower, Guy’s Hospital, St Thomas Street, London SE1 9RT, UK

Abstract

Objectives: To assess the extent of neointimal proliferation and the safety and efficacy of stent redilatation in patients with stents implanted for aortic coarctation or branch pulmonary artery stenosis.

Design: Retrospective observational study.

Setting: Tertiary referral centre.

Patients and interventions: Of 60 patients with Palmaz stents, 12 with coarctation and 12 with branch pulmonary artery stenosis (with 21 stented sites) underwent recatheterisation and stent redilatation.

Results: Neointimal thickening > 1 mm was detected in six of the 12 coarctation stents and at nine of the 21 stented sites in branch pulmonary arteries (five of which had been overdilated at implantation). Eight of the coarctation stents were electively underdilated at implantation. Coarctation stent redilatation increased median (range) lumen diameter from 9.2 (6.3–11.1) mm to 11.7 (9.8–14.1) mm (p = 0.002), decreased gradient from 10.5 (0–20) mm Hg to 0.5 (0–15) mm Hg (p = 0.008), and increased the ratio of stent diameter to descending aorta diameter from 0.66 (0.38–1.02) to 0.85 (0.52–1.2) (p = 0.008). Pulmonary artery stent redilatation increased lumen diameter from 6.9 (3.8–13.5) mm to 8.8 (4.8–14.1) mm (p < 0.001), decreased gradient from 24 (2–62) mm Hg to 12 (0–29) mm Hg (p < 0.001), and increased the ratio of stent diameter to diameter of distal pulmonary artery from 0.66 (0.44–1.5) to 0.86 (0.48–1.88) (p = 0.001). Dilatation of one peripheral pulmonary artery stent resulted in rupture of the vessel distal to the stent.

Conclusions: Neointimal proliferation is precipitated by overdilating stents at implantation. Redilatation using balloons matched to distal vessel diameter increases stent lumen size, but may not optimise vessel diameter. Redilatation is effective whether the indication for redilatation is a resistant stenosis at implantation, underexpansion at implantation, neointimal proliferation, or relative stenosis caused by growth.

  • stent
  • aortic coarctation
  • pulmonary artery stenosis
  • redilatation
View Full Text

Statistics from Altmetric.com

Footnotes

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.