Endovascular Stenting in Transverse Aortic Arch Hypoplasia

Objectives
Describe outcomes from stenting transverse aortic arch hypoplasia.

Background
Hypoplasia of the transverse arch may result in residual systemic hypertension and may be amenable to stenting.

Methods
Outcomes for transverse aortic arch hypoplasia stenting were collated from four centers between 2000 and 2010. Primary endpoints were reduction in peak systolic catheter gradient, dimensions of the stented segment, and systolic right arm blood pressure. Changes in antihypertensive medication and early and late complications were recorded. Data were collated for 21 patients (16 male, 5 female), median age of 16.5 years (range, 0.25-25.9 years) and median weight of 55 kg (range, 4.5-103 kg). 19/21 patients were hypertensive at baseline, excluding the two neonates after repair of interrupted aortic arch.

Results
Median transverse arch diameter increased from 7 to 14 mm after stenting (P <0.001). Median ratio of the transverse arch to descending aorta at the diaphragm level improved from 0.43 to 0.9 (P <0.001). Mean gradient across the hypoplastic transverse arch was 38 mm Hg (range, 14-76) at baseline and 5 mm Hg (range, 0-13) after stenting (P <0.001). There were no deaths and 6 early complications occurred in 5 patients. Follow-up (median 24 months) data were available for 19 patients. 17/19 hypertensive patients had follow-up data. Two neonates developed intimal hyperplasia within the stent with a stent fracture in one. Median systolic blood pressure was 153 mm Hg (range, 117-180) prestent and 130 mm Hg (range, 105-150) poststent (P = 0.0002). In 13/17 patients, the antihypertensive medication could be reduced.

Conclusions
Stenting of transverse aortic arch hypoplasia, although technically challenging, produced good angiographic and haemodynamic results with an early improvement in blood pressure control. These results appear to be sustained in the medium term.