Covered Stents in the Management of Native Coarctation of the Aorta-Intermediate and Long-Term Follow-Up

Objectives
To evaluate the results of covered Cheatham-Platinum stent implantation in the management of native coarctation of the aorta and report intermediate and long-term follow-up.

Background
Covered stents are being used increasingly in severe and complex coarctation of the aorta mainly to reduce risk of aortic wall complications. There is, however, limited data on the intermediate and long-term outcome.

Patients and Methods
Fifty-six patients received 59 covered Cheatham-Platinum stents (January 2002-December 2011) at a single centerin 54 patients as primary treatment and in 2 as a rescue. Mean age was 22.251.2 (11-56) years and mean weight 58.62.1 (32-99) kg. Primary end points were reduction in systolic pressure gradient and an increase in coarctation segment diameter. Changes in antihypertensive medicines and complications were recorded on follow-up.

Results
Mean coarctation segment diameter increased from 4.69 +/- 0.20 to 15.1 +/- 3.2 mm (P<0.0001). The systolic gradient decreased from mean of 51.4 +/- 3.4 to 4.6 +/- 0.7 mm Hg (P<0.0001). There was one death 3 days postprocedure due to cerebral anoxia. There was one dissection diagnosed 24-hr postprocedure. At a mean follow-up of 45.9 +/- 3.9 (3-120) months, all stents were patent and in good position on computed tomography. Four (7.1%) patients underwent successful redilation. Antihypertensive medication was decreased or stopped in 37 (66%) patients.

Conclusions
Covered Cheetham-Platinum stents may be used effectively as therapy of choice in selected patients with severe coarctation of the aorta. Aortic wall complications occur even with covered stents. Covered stents provide a safe alternative to conventional stenting in the intermediate and long-term and can be redilated safely to keep pace with somatic growth.