Balloon coarctation angioplasty in adolescents and adults: Early and intermediate results

doi:10.1016/0002-8703(92)90936-P

American Heart Journal

Volume 124, Issue 1, July 1992, Pages 167-171

https://doi.org/10.1016/0002-8703(92)90936-P Get rights and content

Abstract

Twenty-three adolescent and adult patients with native coarctation of the aorta underwent balloon dilatation. Dissection of the aorta developed in one patient. Data were collected on the remaining 22 patients. They ranged in age from 15 to 55 years (mean 23 ± 9.2 years). Invasive measurement of the peak systolic gradient (PSG) and biplane angiography were performed before and immediately after angioplasty and at follow-up 4 to 48 months (mean 15 months) later. PSG before dilatation was 37 to 100 mm Hg (mean 66.9 ± 19.9 mm Hg) and decreased to 0 to 30 mm Hg (mean 9.1 ± 11 mm Hg) immediately after dilatation (p < 0.001). Restenosis occurred in two patients 6 months after dilatation, and one patient had an incomplete dilatation. These three patients underwent successful redilatation and remained improved 12 to 19 months later. There was no significant change in gradient at repeat catheterization in the remaining 20 patients. PSG was 0 to 20 mm Hg (mean 5.8 ± 7.2 mm Hg). Angiography showed that a small aneurysm developed in one patient immediately after dilatation and in another 6 months later. Eleven patients were restudied more than once, and no change in gradient or size of the aneurysm was noted at mean follow-up 25 months after dilatation. This study demonstrated that balloon angioplasty is an effective method of treating adolescent and adult patient with native coarctation of the aorta. However, because of the uncertain natural history of aneurysm after dilatation, this procedure should be considered investigational until much longer follow-up times are available.

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Immediate results of percutaneous management of coarctation of the aorta: A 7-year single-centre experience
2021, International Journal of Cardiology
Coarctation of the aorta (CoA) is often treated percutaneously. The aim of this study was to describe the immediate results of percutaneous management of native aortic coarctation (NaCoA) and recoarctation of the aorta (ReCoA) at our institution.
We identified all patients with NaCoA or ReCoA who underwent percutaneous dilatation by either balloon angioplasty (BAP) or endovascular stent implantation (ESI) between 2011 and 2017. Success was defined as a residual peak-to-peak gradient (PPG) <20 mmHg or a ≥50% reduction in the gradient if the pre-intervention PPG was <20 mmHg.
63 patients (median age 6.8 years, interquartile range [IQR] 0.4–14.2) were identified. Among 11 patients with NaCoA, 7 underwent BAP and 4 had ESI, and among 52 patients with ReCoA, 42 underwent BAP and 10 had ESI. In patients with NaCoA, BAP was successful in 71%, with median PPG decreasing from 32 mmHg (IQR 25–46) to 17 mmHg (IQR 4–23) (p = .02), and ESI was successful in 100%, with median PPG decreasing from 20 mmHg (IQR 14.5–40) to 2 mmHg (IQR 0–6) (p < .01). In patients with ReCoA, BAP was successful in 69%, with median PPG decreasing from 20 mmHg (IQR 16–31.3) to 9 mmHg (IQR 0–14.3) (p < .001), and ESI was successful in 100%, with median PPG decreasing from 18 mmHg (IQR 11.5–22.8) to 0 mmHg (IQR 0–3.5) (p < .01). ESI was more successful than BAP (p = .01). There was only one complication.
Percutaneous management of CoA is safe and effective in both NaCoA and ReCoA. Stent implantation is more effective than BAP.
Stenting in paediatric and adult congenital heart diseases: A French multicentre study in the current era
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Many stents are used “off-label” during the management of congenital heart diseases (CHD).
To describe indications for, results of, and adverse events associated with stenting in CHD in current practice.
Participation in this study was proposed to all catheterization laboratories that specialize in CHD in France (M3C network). All paediatric and adult CHD cases with stent implantation in 2013 were included retrospectively.
Overall, 207 stents were implanted in 151 patients across 11 centres. Median age was 13.7 years (range, 5 days to 70.1 years). Main procedure indications were branch pulmonary artery angioplasty (n = 46, 29.1%), aortic (re)coarctation stenting (n = 43, 27.2%), percutaneous pulmonary valve implantation (n = 32, 20.2%) and ductus arteriosus stenting (n = 14, 8.9%). The main stents implanted were the CP Stent™ (n = 61, 29.5%), the Max™ LD stent (n = 43, 20.8%), the Valeo^® stent (n = 28, 13.5%) and valved stents (n = 30, 14.5%). Procedures were considered successful in 96.8% of cases (95% confidence interval [CI] 92.8–99.0%). Adverse events were observed in 23 procedures (14.7%, 95% CI 9.5–21.0%). Ductus arteriosus stenting (odds ratio 12.4, 95% CI 2.0–77.5; P < 0.01) and pulmonary revalvulation (odds ratio 5.9, 95% CI 1.1–32.3; P = 0.04) were risk markers for stent-related adverse events.
Stents are used in various CHD catheterization procedures, from infancy to adult age. The adverse events rate is significant and is related to the type of procedure.
De nombreux stents sont utilisés off-label pour le traitement interventionnel des cardiopathies congénitales.
L’objectif principal de cette étude est de décrire les indications, les résultats et les événements indésirables des stents implantés pour le traitement des cardiopathies congénitales en pratique courante.
La participation à cette étude a été proposée à tous les centres français de cardiologie interventionnelle pédiatrique et congénitale (réseau M3C). Parmi 11 centres participants, tous les procédures avec stents, sur une année en 2013 ont été analysés rétrospectivement.
Deux cents sept stents ont été implantés chez 151 patients. L’âge médian était de 13,7 ans (min : 5 jours ; max : 70,1 ans). Les indications principales des procédures étaient l’angioplastie des branches pulmonaires (n = 46, 29,1 %), l’angioplastie de l’isthme aortique (n = 43, 27,2 %), la revalvulation pulmonaire percutanée (n = 32, 20,2 %), et le stenting de canal artériel (n = 14, 8,9 %). Les principaux stents utilisés étaint le CP Stent™ (n = 61, 29,5 %), l’eV3 Max™ LD (n = 43, 20,8 %), le Valeo^® (n = 28, 13,5 %) et les stents valvés (n = 30, 14,5 %). Les procédures ont été réussies dans 96,8 % (IC 95 % 92,8–99,0 %). Des événements indésirables ont été observés dans 23 procédures (14,7 %, IC 95 % 9,5–21,0 %). Le stenting du canal artériel (OR 12,4, IC 95 % 2,0–77,5 ; p < 0,01) et la revalvulation pulmonaire (OR 5,9, IC 95 % 1,1–32,3 ; p = 0,04) étaient des marqueurs de risque de complications reliées au stent.
Les stents sont utilisés dans de multiples procédures du cathétérisme interventionnel des cardiopathies congénitales, de l’enfance à l’âge adulte. Le risque de complications est significatif et semble relié au type de procédure.
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2014, Archives of Cardiovascular Diseases
Citation Excerpt :
Nowadays, with aggressive balloons and stents, successful relief of congenital vascular stenosis is effective in almost all cases. Balloon angioplasty can be complicated by intimal tears, vessel dissection and vessel rupture, particularly during native aortic coarctation dilation [3,4,32]. Intravascular stenting enables scaffolding that compresses dissection flaps against the vessel wall and provides a substrate for smooth neointimal growth.
A ‘stent’ is a tubular meshed endoprosthesis that has contributed to the development of interventional catheterization over the past 30 years. In congenital heart diseases, stents have offered new solutions to the treatment of congenital vessel stenosis or postsurgical lesions, to maintain or close shunt patency, and to allow transcatheter valve replacement. First, stents were made of bare metal. Then, stent frameworks evolved to achieve a better compromise between radial strength and flexibility. However, almost all stents used currently in children have not been approved for vascular lesions in children and are therefore used ‘off-label’. Furthermore, the inability of stents to follow natural vessel growth still limits their use in low-weight children and infants. Recently, bioresorbable stents have been manufactured and may overcome this issue; they are made from materials that may dissolve or be absorbed in the body. In this review, we aim to describe the history of stent development, the technical characteristics of stents used currently, the clinical applications and results, and the latest technological developments and perspectives in paediatric and adult congenital cardiac catheterization.
Un stent est une endoprothèse maillée tubulaire qui a contribué à l’essor du cathétérisme interventionnel sur les trente dernières années. En cardiologie pédiatrique et congénitale, les stents ont offert de nouvelles solutions pour traiter des sténoses congénitales des vaisseaux ou des lésions postopératoires, pour maintenir ou occlure la perméabilité d’un shunt et pour permettre le remplacement valvulaire par voie percutanée. À l’origine, les stents étaient formés d’une structure métallique « nue ». Puis plusieurs structures de stents ont été dessinées pour un meilleur compromis entre force radiaire et flexibilité. Néanmoins, la plupart des stents actuellement utilisés n’ont pas été développés pour les lésions congénitales de l’enfant et sont utilisés « off-label ». De plus, l’incapacité des stents à suivre la croissance naturelle des vaisseaux limite leur usage chez les enfants de faible poids et chez les nourrissons. Des stents biorésorbables ont récemment été développés avec la capacité d’être dégradés par l’organisme. Dans cette revue générale, nous avons souhaité décrire l’historique de développement des stents, les caractéristiques techniques des stents actuellement utilisés, les applications cliniques et les résultats, les dernières évolutions technologiques et les perspectives dans le domaine des cardiopathies congénitales.
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The unusual hypertensive patient
2012, Journal of the Saudi Heart Association
Citation Excerpt :
Many now recommend this technique as an alternative for surgery or recoarctation of previously operated coarctation [17,18]. Some extend this preference to the unoperated or native coarctation [19–22]. Nowadays Stent implantation is considered the therapy of first choice for aortic coarctation in adults [23–25].
Intravascular stenting for the treatment of coarctation of the aorta in adolescent and adult patients
2011, Archives of Cardiovascular Diseases
In the past 10 years, stent implantation has become a real alternative to surgery in the management of both native and recurrent coarctation of the aorta in adolescents and adults. The purpose of this report is to provide a detailed review of stent implantation techniques, including pre-procedure imaging, technical aspects and results. The success rate is usually high (around 90%), and the procedure results in an increase in the diameter of the coarcted segment, a decrease in the transisthmic systolic gradient and a better control of systemic hypertension. The most serious complication, rupture of the aorta, can be fatal, but is rare (< 2%). Aneurismal dilatation is another potential problem that occurs in around 5–9% of cases, and may be related to overstretching and pre-stent dilatation, so these should be avoided. It is necessary to point out that most of these aneurysms are small and conservatively managed. Restenosis is another complication that may result from neointimal proliferation, stent recoil and stent fracture. Balloon dilatation with a higher inflating pressure or repeat stent implantation is proposed herein. A comparison with surgery is also discussed, and a follow-up protocol is proposed to capture late complications. Owing to good initial and intermediate results, stent implantation is nowadays considered as a first-line therapy in most adolescents and adults with (re)coarctation of the aorta.
La mise en place de stent est devenue depuis une dizaine d’année une véritable alternative thérapeutique à la chirurgie dans le traitement des coarctations de l’aorte chez l’adolescent ou l’adulte. Le propos de cet article est une revue détaillée de cette technique comportant l’imagerie avant implantation, les aspects techniques et les résultats. Le taux de réussite avoisine les 90 % avec une augmentation du diamètre coarctée, une diminution du gradient trans-isthmique et un meilleur contrôle de l’HTA. La complication principale est la rupture de l’aorte (< 2 %) qui peut être fatale. Le développement d’un anévrysme est une autre complication (5–9 %) qui peut être liée à une pré- ou sur-dilatation qui doivent être proscrites. Il est nécessaire de signaler que la plupart des ces anévrismes sont minimes et ne nécessitent aucun geste complémentaire. La resténose (recoarctation) est une autre complication qui peut résulter d’une prolifération intimale, d’un « recoil », ou d’une fracture de stent. Dans ces cas, une dilatation avec un ballon à haute pression voire un re-stenting peuvent être réalisés. Une comparaison avec la chirurgie est aussi abordée et un protocole de suivi post-implantation proposé. En fait, en raison des bons résultats immédiats et à distance, la mise en place d’un stent est aujourd’hui proposée souvent en première intention dans le traitement de la coarctation de l’aorte chez l’adolescent et l’adulte.

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Balloon coarctation angioplasty in adolescents and adults: Early and intermediate results

Abstract

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