Treatment of aortic isthmus atresia with a covered stent

We report on successful treatment of an elderly patient with congenital aortic isthmus atresia with a covered stent. © 2008 Wiley‐Liss, Inc.     

Feasibility and efficacy of stent redilatation in aortic coarctation

Objectives : We evaluated the efficacy and safety of stent redilation in patients with aortic coarctation (COA). Methods and Results : In our retrospective study of 28 stent redilation procedures on 22 patients, the interval between implantation and redilation ranged from 2.5 month to 11 years (median 18 months). Ten patients had native COAs, one had repaired interrupted aortic arch. The remaining patients had residual COAs after surgery. Stent redilation was successful in 26 procedures. Pressure gradients decreased from a mean of 26 ± 13.8 mm Hg to 7.9 ± 6.52 mm Hg (P < 0.001). The mean diameter of the stents increased from 9.19 ± 3.29 mm to 12.1 ± 3.68 mm (P < 0.001). In a patient with Williams‐Beuren syndrome, massive neointimal proliferation made stent redilation impossible. One other patient developed aortic aneurysm after redilation and was operated after 3 years. Conclusions : Stent redilation for aortic COA is a safe and successful procedure. © 2008 Wiley‐Liss, Inc.     

Emergency stent graft deployment for acute aortic rupture following primary stenting for aortic coarctation.

We present a case of endovascular stenting for aortic recoarctation complicated by acute aortic rupture, which was successfully treated by emergency stent graft deployment. This case illustrates the potential serious complication that can occur during aortic stent dilatation and how the prompt deployment of a stent graft helped to change the clinical outcome of this life-threatening situation.     

Long-term follow-up after endovascular treatment of aortic coarctation with bare and covered Cheatham platinum stents

Background

Endovascular treatment of aortic coarctation (CoA) in children and adults frequently requires stent implantation. The aim of this study was to analyze long-term results after CoA treatment with bare and covered Cheatham-Platinum^TM (CP) stents in our institution and to derive recommendations for the differential use of these stent types.

Methods

In this retrospective single institution study, 212 patients received endovascular CoA treatment with bare (n = 71) and covered (n = 141) CP stents between September 1999 and July 2021, respectively. The indications for treatment were native CoA in 110/212 patients (51.9%) and re-coarctation after primary surgical or interventional treatment in 102/212 patients (48.1%). Median patient age at endovascular CoA treatment was 18.8 years [IQR 11.9; 35.8]. Long-term follow-up was available in 158/212 patients (74.5%) with a median follow-up of 7.3 years [IQR 4.3; 12.6].

Results

Procedural success was achieved in 187/212 (88.2%) patients. Survival rate was 98.1% after 5, and 95.6% after 10 and 15 years, respectively. The probability of freedom from re-intervention was 93.0% after 5, 82.3% after 10 and 77.8% after 15 years, respectively. Freedom from re-interventions (44/158, 27.8%) did not differ between patients who received bare or covered CP stents (p = 0.715). Multivariable risk factor analysis identified previous CoA surgery (HR: 2.0, 95% confidence interval (CI): 1.1–3,9, p = 0.029), postdilatation (HR: 2,9, 95% CI: 1.1–6.3, p = 0.028) and age at intervention (HR: 0.96, 95% CI: 0.94–0.99, p = 0.002) as independent risk factors for re-intervention. Peri-procedural complications occurred in 15/212 (7.1%) patients (dissection/thrombosis of vascular access vessel: n = 9; bleeding: n = 1; stent dislocation: n = 2; aortic dissection/aortic wall rupture: n = 3). Long-term complications were observed in 36 patients and included stent fracture (n = 19), aneurysm formation (n = 14), endoleak (n = 1) and subclavian artery stenosis (n = 2). Peri-procedural and long-term complications did not differ between patients who received CoA treatment with bare or covered CP stents (all p > 0.05).

Conclusion

Endovascular treatment of CoA using bare or covered CP stents can be performed safely and effectively with excellent long-term results. Survival, re-intervention and complication rate did not significantly differ between both stent types. However, individual stent selection is advisable with regard to CoA morphology and severity as well as patient age.     

Use of the Gore Viabahn VBX balloon‐expandable endoprosthesis in the congenital heart disease population

The Gore Viabahn VBX balloon‐expandable endoprosthesis (W. L. Gore & Associates, Flagstaff, AZ) is a flexible covered stent that is FDA‐approved for the treatment of iliac artery stenosis, including lesions at the aortic bifurcation. In this case series, we report the first use of the VBX covered stent in congenital heart disease, highlighting several of its unique advantages.     

Transcatheter therapy for aortic coarctation with severe systemic hypertension during pregnancy

Aortic coarctation is an unusual cause of hypertension during pregnancy and its management is not clarified. We report transcatheter balloon dilatation and stenting for native aortic coarctation in a 22‐year‐old pregnant woman with severe and uncontrolled systemic hypertension. Arterial blood pressure could be successfully controlled with medical treatment during the rest of the pregnancy and the patient underwent uneventful delivery. No adverse events or recoarctation was observed during 24 months clinical follow‐up. In conclusion, native aortic coarctation can be successfully treated during pregnancy with transcatheter therapy. More experience is needed to confirm the safety and efficacy of such management. © 2012 Wiley Periodicals, Inc.     

Use of 3D rotational angiography to perform computational fluid dynamics and virtual interventions in aortic coarctation

Computational fluid dynamics (CFD) can be used to analyze blood flow and to predict hemodynamic outcomes after interventions for coarctation of the aorta and other cardiovascular diseases. We report the first use of cardiac 3‐dimensional rotational angiography for CFD and show not only feasibility but also validation of its hemodynamic computations with catheter‐based measurements in three patients.     

First in man use of the Advanta trademark V12 ePTFE‐coated stent in aortic coarctation

The treatment of aortic coarctation has classically been surgery, but recent advances have seen the increasing adoption of percutaneous catheter based techniques to correct this problem. We describe a first in man use catheter technique with the Advanta ePTFE coated stent via a 9Fr access. © 2009 Wiley‐Liss, Inc.     

Transcatheter creation of bidirectional cavopulmonary connections by needle punctures in two patients

We report on two patients who received a transcatheter cavopulmonary connection by a needle puncture under deep conscious sedation. In both patients, the vessel‐to‐vessel connection was achieved by a venous access into the superior caval vein and direct needle puncture of the pulmonary artery. The two cavopulmonary anastomoses were held open by a covered stent and a bare‐metal stent, respectively.     

Ductal stent endocarditis resulting in a large aortic pseudoaneurysm

An infant with ductal dependent pulmonary blood flow who underwent neonatal ductal stenting and, 4 months later, developed ductal stent endocarditis due to Streptococcus gallolyticus subsp. pasteurianus was described. The infection was associated with a moderate aortic pseudoaneurysm and the patient was treated with antibiotics as well as surgical aortic pseudoaneurysm repair. This novel and unusual complication of ductal stent placement warrants reporting.     

开窗支架型血管治疗近肾腹主动脉瘤的初步临床结果

目的回顾性分析开窗支架型血管治疗近肾腹主动脉瘤（AAA）的初步结果。方法4例合并严重疾病无法行开放手术的近肾AAA患者,根据术前CT数据定制个体化开窗支架型血管。于全身麻醉下置人此支架型血管并置入肾动脉支架。结果术后即时造影示各分支血管血流通畅,支架形态良好,两例有少量近端I型内漏。术后3个月复查4例患者支架形态正常,两例I型内漏均消失,但另一名患者出现Ⅱ型内漏。结论应用个体化开窗支架型血管治疗近肾AAA近期效果良好。