Simultaneous treatment of native coarctation of the aorta combined with patent ductus arteriosus using a covered stent.

A 19-year-old girl with coarctation of the aorta and patent ductus arteriosus underwent simultaneous treatment of native coarctation and closure of ductus arteriosus using a covered Cheatham-Platinum stent. This technique may be used as an alternative to other forms of interventional therapy or surgery for this combination of lesions in adolescents and adults.     

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.     

Aneurysm formation after drug‐eluting balloon treatment of drug‐eluting in‐stent restenosis: First case report

A 55‐year‐old male underwent paclitaxel‐eluting stent implantation in a bifurcation lesion of his left anterior descending artery (LAD) during an episode of unstable angina in 2008. A late in‐stent restenosis developed 15 months after implantation of the drug‐eluting stent (DES) and was treated with paclitaxel eluting balloon. Two months later, during angiography for functional assessment of the significance of lesions in the circumflex artery, an aneurysm at the place of drug‐eluting balloon (DEB) inflation was observed. The patient was left on double antiplatelet therapy and scheduled for clinical observation after 3 months and control coronary angiography after 6 months for aneurysm progression follow‐up. © 2012 Wiley Periodicals, Inc.     

Endovascular maneuvers for contralateral stent graft limb misplacement in endovascular aortic repair

Cannulation and placement of the contralateral stent graft limb during endovascular aortic repair (EVAR) procedure are crucial steps as mispositioning may lead to conversion to open aortic repair. Endovascular bail-out strategies for stent graft relocation in EVAR are underreported though detailed knowledge may facilitate application and prevent conversion. We present three endovascular bail-out strategies for repositioning of a mispositioned contralateral stent graft limb. (1) Retraction of the mispositioned component with an inflated reliant balloon and placement of an interposition stent graft after successful cannulation; (2) Push-maneuver of the mispositioned stent graft into the infrarenal aortic aneurysm with an inflated reliant balloon supported by a large lumen introducer sheath and (3) Parallel placement of a second contralateral stent graft limb displacing the mispositioned one against the atrial wall in cases with adequate vessel diameter. Prevention of stent graft mispositioning by applying recognized tests to ensure correct placement are essential, following the slogan: check twice, deploy once.     

Treatment of aortic arch aneurysm with a NuMED‐covered stent and restoration of flow to excluded left subclavian artery: Perforation and dilation of e‐PTFE can be done!

We describe a case using a NuMED‐covered Cheatham‐Platinum (CP) stent (NuMED, Hopkinton, NY) to treat an aneurysm after previous balloon angioplasty and bare stent implantation for coarctation of the aorta (CoA). Exclusion of the left subclavian artery (LSCA) was anticipated. After wire perforation of the covered CP stent, balloon angioplasty was performed through a stent cell to recannulize the LSCA. © 2009 Wiley‐Liss, Inc.     

Aortic aneurysm repair with endovascular grafts: developing a graft surveillance program.

The objective of this study was to describe the development of a comprehensive surveillance program for monitoring the long-term follow-up of endoluminal stent graft (ELG) patients. Despite high procedural success rates, ELG patients remain at ongoing risk for aneurysm sac expansion, rupture, and other adverse events that make long-term surveillance imperative. As they perform more ELG, practitioners face increased logistical difficulty performing appropriate patient follow-up. A computer-based data ELG registry was created using Epi Info, a program developed by the Centers for Disease Control and Prevention that enables users to design a data entry form, enter data, and perform statistical analyses. The database has been used to track 259 patients (214 men and 45 women) who underwent ELG between November 1999 and October 2003. One-year follow-up was available for 182 patients, 2-year follow-up for 104 patients, and 3-year surveillance data for 40 patients, which represent follow-up rates of 89.6%, 78.8%, and 61.5%, respectively. There were 25 late deaths. The Kaplan-Meier estimate for 1-year survival was 92.5%. Twenty-one patients underwent 24 secondary angiographic procedures at a mean 8.6 +/- 10.3 months (range, 1-37.6) after stent-graft repair. No mortality was observed in association with a secondary intervention. There were no late conversions to open aneurysm repair. The Kaplan-Meier estimate for freedom from secondary intervention for all patients at 1 year was 91.0%. A computer-based registry facilitates appropriate and timely patient follow-up and may improve the long-term outcome from ELG.     

Transcatheter double stent implantation for treatment of middle aortic coarctation syndrome

A 13‐year‐old boy presented with severe systemic hypertension. His upper limb blood pressure measured 190/100 mm Hg and lower limb blood pressure measured 98/64 mm Hg. The brachial pulses were bounding and femoral pulses were not palpable. Echocardiography and magnetic resonance angiography confirmed middle aortic syndrome. There was severe diffuse thoraco‐abdominal coarctation with continuous Doppler run‐off. Cardiac catheterization was undertaken and using a retrograde approach two Advanta V12 stents were implanted in the complex thoraco‐abdominal coarctation. The gradient across the coarctation was reduced from 80 to 40 mm Hg gradient with a significant improvement in the luminal diameter of the aorta. His upper limb blood pressure reduced to 142/78 mm Hg six weeks later. © 2013 Wiley Periodicals, Inc.     

Early and mid‐term results with the growth stent—A possible concept for transcatheter treatment of aortic coarctation from infancy to adulthood by stent implantation?

Aims : Evaluation of the Growth Stent—a stent consisting of two stent halves connected by reabsorbable sutures—for the treatment of aortic coarctation in infants. Methods and Results : Surveillance study of 13 Growth Stents implanted in 12 patients aged 1–15 months (median 5 months). Body weight ranged from 3.4–12.8 kg (median 5.4 kg). Eight patients suffered from aortic (re‐)coarctation, four of them from stenosis of the aortic anastomosis after a Norwood I procedure. The follow‐up period was 24 months (11–51 months). Pressure gradients immediately after stent implantation decreased from 30 mm Hg (range 20–50 mm Hg) to 8 mm Hg (range 0–15 mm Hg). Five patients had one (3 pts) or two (2 pts) balloon dilations 3–28 months (median 12 months) after Growth Stent implantation. The median pressure gradient decreased from 25 mm Hg (range 15–30 mm Hg) to 15 mm Hg (range 5–25 mm Hg). Six patients received a large stent after 19–34 months. Median body weight was 11.8 kg (9.4–15 kg). Conclusions : The Growth Stent is suitable for the acute treatment of aortic coarctation in infants and can be overstented later on—if necessary—with a larger stent without causing restriction. © 2008 Wiley‐Liss, Inc.     

Transluminal repair of an infrarenal aortoiliac aneurysm by a combination of bifurcated and branched stent grafts

Transfemoral endovascular repair with a combination of bifurcated and branched stent grafts enables aortoiliac reconstruction with internal iliac perfusion preserved. We report a case of successful endovascular repair of aortoiliac aneurysm with use of a bifurcated and branched stent-graft. Cathet. Cardiovasc. Intervent. 47:491–494, 1999. © 1999 Wiley-Liss, Inc.     

新一代Captivia后释放输送系统Valiant主动脉覆膜支架使用初步体会

目的 初步评估Valiant Captivia主动脉覆膜支架在主动脉Stanford B型夹层主动脉腔内修复术（thoracic endovascular aortic repair,TEVAR）中应用的有效性及安全性.方法 收集从2012年1月至2012年6月在广东省人民医院住院,行Stanford B型主动脉夹层TEVAR,并使用Valiant支架传统输送系统或新一代Captivia输送系统的Valiant覆膜支架系统、病历资料完整的患者共40例.其中使用Valiant组25例,使用Captivia组15例.所有患者采用局部麻醉,经皮穿刺技术,使用快速右心室起搏进行起搏过程中控制性降压,通过造影进行支架定位.比较两组的移植物定位准确性、手术时间、内漏和并发症发生率等.结果 两组的基线资料包括年龄、性别及并发疾病、基础血压、支架释放时血压及介入后血压比较,差异无统计学意义（P＞0.05）.两组围术期心率包括基础、支架释放时,及介入治疗后心率和手术时间比较,差异无统计学意义（P＞0.05）.但从移植物定位准确性看,Captivia组与Valiant组相比较少产生移植物移位,差异有统计学意义[（4.9±2.4）mm vs.（3.3±1.8）mm,P=0.028].两组支架释放后即时造影发现残留内漏发生率及术后出现脊髓缺血的发生率比较,差异无统计学意义（P＞0.05）.结论 与原Valiant支架相比,新一代使用后释放设计的Valiant（R） Captivia支架释放时能更安全、简便地调整支架位置,有助于支架的精确释放.     

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。     

Lengthening of proximal implantation site during endovascular repair of thoracic aortic aneurysm: Preservation of carotid patency with retrograde trans endograft deployment of a carotid stent

Endovascular repair of descending thoracic aortic aneurysms with a reduced proximal implantation site represents a technical challenge. Surgical procedures before endovascular exclusion can be necessary to increase the length of the proximal landing site to avoid type 1 endoleaks. We present a case of endovascular exclusion of a descending thoracic aortic aneurysm with the endograft placed proximal to the left common carotid artery. Flow to this arch was preserved reconstructing the carotid ostium with the retrograde implantation of a carotid stent that was placed extending across an orifice created in the deployed endograft by puncture and balloon dilatation. © 2008 Wiley‐Liss, Inc.     

Pharos neurovascular intracranial stent: Elective use for a symptomatic stenosis refractory to medical therapy

The Warfarin‐Aspirin Symptomatic Intracranial Disease study investigators demonstrated that medically managed patients with symptomatic intracranial stenosis experience a 7–11% annual stroke risk. Early treatment efforts utilized balloon‐mounted coronary stents, which provided excellent angiographic results (postprocedure stenoses <10%), versus percutaneous transluminal angioplasty (PTA) alone (40%). However, the rigidity of balloon‐mounted coronary stents provided limited access to the tortuous cerebrovasculature. Self‐expanding stents became available for intracranial stenosis treatment in 2002. With increased flexibility, immediate results were encouraging (approximately 30% residual stenosis). However, midterm results have demonstrated disappointingly high rates of restenosis. To address these issues, the Pharos Neurovascular Stent System (Pharos, Micrus Endovascular, San Jose, CA) was developed. The Pharos is a balloon‐expandable stent mounted on a rapid‐exchange PTA catheter especially designed for intracranial endovascular applications. Utilizing the Pharos, we obtained an outstanding angiographic result (0% residual stenosis), with no associated morbidity. The patient was discharged home on postprocedure day 1 and remained symptom‐free, with no in‐stent stenosis, 3 months later. Our experience with the Pharos supports early literature suggesting that this stent may be a valuable treatment option for patients with medically refractory intracranial stenosis. © 2009 Wiley‐Liss, Inc.     

Improved technique for use of half-stents remounted on a stent delivery system

The use of half-length intracoronary Johnson & Johnson stents has been described in a number of settings. Half-stents are useful for very short lesions, avoidance of bifurcations or side-branches, ostial stenosis, covering gaps between adjacent stents, and for dissection adjacent to stents caused by postdilatation. Previously described methods for use of half-stents have involved bare stents, or significant manipulation of either the stent or the delivery sheath for remounted half-stents. We describe a method for half-stent preparation and delivery that does not involve distortion of the stent or the delivery sheath. The risk of stent loss, as can occur with bare stents, is diminished. The geometry of the stent is preserved since it is not expanded and then recrimped, and the end of the delivery sheath is not flared or distorted, which may interfere with stent delivery. © 1996 Wiley-Liss, Inc.