Collapse of the advanta V12 large diameter covered stent following implantation for aortic coarctation

We report a case of collapse of the Advanta V12 Large Diameter (LD) covered stent following previous successful implantation for native aortic coarctation. This unreported complication was successfully managed with subsequent stent redilation and implantation of two covered Cheatham‐Platinum stents within the collapsed Advanta V12 stent. This case highlights the importance of correct stent apposition to the aortic wall and also raises some concerns regarding the radial strength of the Advanta V12 stent. © 2013 Wiley Periodicals, Inc.     

Self‐expanding and balloon expandable covered stents in the treatment of aortic coarctation with or without aneurysm formation

Objectives: We describe our complete experience with covered stent implantation for aortic coarctation including short‐ to medium‐term outcomes. Background: Coarctation of the aorta is a heterogeneous disease process with multiple associated complications both with and without treatment. Covered stents have evolved to provide greater support to the aortic wall and a varied approach with choice of stent tailored to the anatomy of the patient is required. Methods: We retrospectively analyzed consecutive patient data from two congenital heart centers from March 2003 to October 2007. Results: We implanted 38 covered stents in 37 patients (20 female) of which three were self‐expanding stents. Median age was 29.6 years (9–65) with median weight of 71.5 kg (35–95). The indications for stent placement were native coarctation (n = 13); recurrent coarctation following surgical treatment (n = 11); aneurysm associated with previous coarctation surgery (n = 7); aorto‐bronchial fistula leading to acute hemoptysis (n = 2); stent fracture (n = 1); associated arterial duct (n = 2). One patient had a combination of acquired coarctation and false aneurysm. The median screening time was 10 min (3–22). The median systolic gradient of 26 mm Hg (10–60) was reduced to 4 mm Hg (0–20) postprocedure (P < 0.001). There were no deaths on median follow up of 11.5 months (1–56). One patient developed aortic rupture during the procedure and required emergency surgery. Conclusion: Covered stent implantation for treatment of aortic coarctation is safe and highly effective in selected patients. Self‐expanding stent grafts may be preferable to balloon expandable stents when there is aneurysm formation in the setting of aortopathy. © 2008 Wiley‐Liss, Inc.     

Coarctation of the aorta treated with the Advanta V12 large diameter stent: Acute results

Objectives: To report on the early results of treatment of coarctation of the aorta by dilation with a new polytetrafluoroethylene covered stent. Background: Transcatheter dilation of aortic coarctation carries the risk of aneurysm or rupture. Covered stent implantation reduces this risk but requires a large delivery system. The Advanta V12 LD covered stent is premounted and requires a 9–11 Fr delivery system. Methods: Covered stents on balloons of a diameter sufficient to anchor the stent in the coarctation were implanted using the smallest available delivery system. Secondary dilation with larger diameter balloons was performed until the pressure gradient was <20 mm Hg and the stent was opposed to the aortic wall. Results: Twenty‐five patients with aortic coarctation underwent stent implantation. Coarctation diameter increased from (6.3 ± 3.5) mm to (14.4 ± 2.3) mm (P < 0.0001). Peak pressure gradient decreased from (25.3 ± 11.6) mm Hg to (2.5 ± 3.0) mm Hg (P < 0.0001). The stent achieved the desired diameter in all cases. There were no complications. At short‐term median follow‐up of 4.9 months, all patients are alive and well with no evidence of recoarctation or aneurysm. Conclusions: These initial results show that the covered Advanta V12LD stent is safe and effective in the immediate treatment of coarctation of the aorta through a low profile delivery system of 8–11 Fr. Long term follow up is required. © 2009 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.     

Transcatheter treatment of “complex” aortic coarctation

A young woman, submitted to aortic coarctation repair in early infancy, was referred with clinical and echocardiographic signs of severe recoarctation. Spiral CT scan confirmed the aortic isthmus obstruction but imaged also a huge aneurysm distal to the coarctation site, from which arose a large aberrant right subclavian artery. In cardiac catheterization, this vessel showed an upper‐to‐lower flow direction and its closure was deemed mandatory to abolish a major feeding source to the aneurysmal sack. Thus, this anomalous vessel was occluded with an Amplatzer Duct Occluder device and multiple covered Cheatham‐Platinum stents were telescopically implanted into the thoracic aorta to dilate the coarctation and exclude the aneurysm. In conclusion, percutaneous transcatheter treatment is feasible, safe, and cost‐effective even in aortic arch obstructions with complex anatomic arrangement. © 2010 Wiley‐Liss, Inc.     

Percutaneous treatment of aortic isthmus atresia

Background : Limited data exists in the literature concerning the percutaneous treatment of complete aortic isthmus atresia. Patients and Methods : Between January 2007 and November 2010, 40 subjects underwent percutaneous treatment of aortic coarctation in our catheterization laboratory. Four out of 40 had aortic isthmus atresia with complete interruption. Median age at procedure was 48 years (range, 32–63 years). All subjects had history of arterial systemic hypertension refractory to medical treatment. Two subjects had a previous history of haemorrhagic stroke. All procedures were performed under general anesthesia and orotracheal intubation. In each case radial and femoral artery access was obtained. A radiofrequency (RF) system (Baylis MedComp Inc, Montreal, Canada) consisting of a Nykanen 0.024'' RFguidewire and coaxial microcatheter were used to perforate and cross the atretic segment. A guidewire was then snared and an artero‐arterial circuitcreated. The area was predilated by using coronary angioplasty balloons. A 12 Fr Mullins long sheath was advanced and an E‐PTFE covered 8Zig Cheatham‐Platinum stent implanted. Patients were monitored in hospital for 48–72 hr. Follow‐up was performed at 1, 3, 6, 12 months, and yearly thereafter. Results : Percutaneous recanalization of the atretic segment was performed successfully in all subjects. Mean fluoroscopy and procedure times were 30 ± 6 and 90 ± 15 min, respectively. After implantation, the gradient decreased significantly (prestent: mean value 52.25 mm Hg [range 33–70 mm Hg] versus post stent: mean value 3 mm Hg [range, 0–10 mm Hg] [P < 0.0001]). The stents were placed in the correct position in all subjects and no immediate complications occurred. During a mean follow‐up of 19 months (2–41 months), there were nosignificant complication. All subjects had arterial systemic blood pressure within the normal range. In two out of four patients single agent antihypertensive drug therapy was needed. The first patient in our series was treated conservatively and needed further stent dilation with a second procedure approach, eight months after the initial stent implantation, performed without incident. Conclusions : Our data show that use of radiofrequency energy perforation and covered CP stent implantation is a safe, effective, and promising tool for treatment of complete aortic isthmus atresia. © 2011 Wiley Periodicals, Inc.     

Innovative resource utilization to fashion individualized covered stents in the setting of aortic coarctation

Objectives: We describe our experience with self‐fabricated covered stents in the setting of coarctation of the aorta (CoA). Background: Balloon‐expandable covered stents are increasingly being utilized to treat CoA in older children and adults. These stents however, are not available in the United States limiting the interventionalist's ability to treat this condition safely and effectively. Methods: Retrospective analysis and follow‐up data review of our complete experience with self‐fabricated covered stents for CoA. Stents were fashioned by suturing an appropriate length of tubular polytetraflouroethylene to a bare metal stent and deploying this stent across the coarctation in a standardized fashion. Results: Over a 9‐year period we implanted 53 balloon‐expandable stents in 49 patients with CoA. Of these 13 were self‐fabricated covered stents deployed in 13 patients (7 male). Median age at implantation was 25.4 years (range, 8.7–49.5 years) with median weight of 65.5 kg (range, 28–168 kg). Indications for stent placement were native coarctation/aortic atresia (n = 9), aneurysm formation (n = 3), and re‐coarctation (n = 1). The median systolic pressure gradient across the coarctation of 33 mm Hg (range, 12–69 mm Hg) was reduced to 3 mm Hg (range, 0–19 mm Hg) post procedure (P < 0.001). There were no deaths on median follow‐up of 44 months (range, 1–83 months). One patient developed acute contained extravasation at implantation, treated with a self‐expanding stent graft. Another patient required thrombectomy for femoral arterial thrombosis. Conclusions: Innovative application of available materials adds to the armamentarium of the interventionalist. Our self‐fabricated covered stent provides effective gradient reduction with no compromise in stent delivery or durability on follow‐up. © 2011 Wiley‐Liss, Inc.     

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.     

Covered stents in patients with congenital heart defects.

OBJECTIVES: To evaluate the role of covered Cheatham-Platinum stents in patients with congenital heart disease. BACKGROUND: There are limited data in the literature about the use of covered stent in patients with congenital heart disease. METHODS: Between January 2004 and September 2005, covered Cheatham-Platinum stents were implanted into 18 patients with congenital heart defects (9 males, median age 19 years, range 8-45 years). Sixteen had aortic coarctation or recoarctation (8 with associated aneurysm, 1 with patent ductus arteriosus, 3 with an irregular wall, 4 with subatretic native aortic coarctation) (group 1). Two subjects with univentricular heart circulation were treated because of complex right-to-left shunting (Group 2). RESULTS: Group 1: The stents used ranged from 34 to 45 mm in length. The mean fluoroscopy and procedure times were 12+/-8 and 70+/-15 minutes, respectively. After implantation, the gradient across the stenosis decreased significantly (prestent median value 37 mmHg) (range 20-50 mmHg) versus poststent: median value 0 mmHg (range 0-10 mmHg) (P<0.0001). Vessel diameter increased from a median value of 6 mm (range 0-11) to a median value of 14 mm (range 10-23) (P<0.0001). Stents were placed in the correct position in all subjects. No complications occurred and on angiographic control the stenoses had been relieved and the aneurysms completely excluded. Group 2: Implantation of the covered stents successfully abolished right-to-left shunting in both patients. Both had significant increases in oxygen saturation and no complications occurred. Follow-up: During a median follow-up of 7 months (1-19 months), the results were stable without any complications. CONCLUSION: Covered Cheatham-Platinum stents are very useful tools for treating various congenital cardiovascular malformations.     

Stent implantation for aortic coarctation and recoarctation

OBJECTIVE—To determine the early results of balloon expandable stent implantation for aortic coarctation or recoarctation.
DESIGN—Prospective observational study.
SETTING—Two paediatric cardiology tertiary referral centres.
PATIENTS—17 patients, median age 17 years (range 4.4 to 45) and median weight 61 kg (17 to 92). Six had native aortic coarctation and 11 had aortic recoarctation; 14 had upper limb systolic hypertension. Of those with recoarctation, eight had had at least one previous balloon dilatation attempt and two of these patients also had further surgical interventions.
INTERVENTION—Balloon expandable Palmaz iliac stent implantation.
MAIN OUTCOME MEASURES—Systolic pressures gradients, minimum aortic diameter, upper limb blood pressures, and incidence of aneurysm formation.
RESULTS—18 stents were implanted during 18 procedures in the 17 patients. Mean peak systolic pressure gradient fell from 26 mm Hg (95% confidence interval (CI), 21 to 31 mm Hg) before to 5 mm Hg (2 to 8 mm Hg) after stent implantation (p < 0.001), and mean minimum aortic diameter increased from 7 mm (95% CI, 6 to 8 mm) before to 11.3 mm (10 to 12.6 mm) after implantation (p < 0.001). Complications occurred in five patients (bleeding in two, stent migration in two, and aneurysm formation in one). Two patients remained borderline hypertensive and eight were receiving antihypertensive treatment at most recent assessment.
CONCLUSIONS—Stent implantation for aortic recoarctation and native coarctation gives good immediate results. Careful follow up is necessary to evaluate complications and the long term effect on blood pressure.


Keywords: coarctation; aortic recoarctation; stents     

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.     

Endovascular stent implantation in patients with stenotic aortoarteriopathies: early and medium-term results.

Data regarding stent implantation for stenotic aortoarteriopathy (SAA) are incomplete. We report on nine patients with this rare syndrome who underwent arterial stent implantation. Indications, results, and complications for patients with SAA were reviewed. Nine patients underwent 11 procedures. Twenty-two stents were implanted in the aorta or brachiocephalic vessels. Five patients had diffuse stenoses, three patients had middle aortic syndrome, and one patient had thoracic and abdominal coarctation. Associated diagnoses included Williams syndrome (2), neurofibromatosis (2), Takayasu's (1), and congenital rubella (1). Median gradient was 60 mm Hg (20-140 mm Hg). Poststent gradient was 15 mm Hg (0-60 mm Hg; P < 0.001). Additional stents were implanted in two patients and five underwent stent redilation. Two patients (22%) were found to have aneurysm formation. Stent implantation effectively provides gradient relief in SAA. Gradient reduction persists or is amenable to redilation. Importantly, however, uncomplicated stent implantation does not preclude aneurysm formation and may be more common than in traditional patient groups.     

Treatment of aortic aneurysm with covered stent. Case report.

The authors present the case of a thirteen-year-old boy with aortic coarctation, which was surgically corrected at the age of 2.5 months. He subsequently developed recoarctation, which was treated with balloon dilatation. Recently, recoarctation and an aortic aneurysm were observed, which were corrected with covered stent implantation. We discuss various techniques for correction of aortic coarctation, as well as their advantages and disadvantages.     

Endovascular stent placement is an acceptable alternative to reoperation in selected infants with residual or recurrent aortic arch obstruction

Objective : To describe endovascular stent placement in infants as a technically feasible option in circumstances where surgery is considered less favorable. Background : Endovascular stent placement has become established as a first line therapy for native coarctation of the aorta or recoarctation in older children where stents capable of expansion to adult size can be placed safely. Surgery remains the therapy of choice in infants and young children. The management of aortic arch obstruction in infants is, however, frequently complicated by complex anatomy or clinical condition that may make surgery or further surgery an unattractive option. There is little reported data and the implications thereof of transcatheter stent placement in aortic arch obstruction in infants. Methods : Between August 2004 and November 2009, 11 patients had aortic arch obstruction treated with endovascular stent placement. The median age and weight at first stent placement was 46 days (range 3–399 days) and 4 kg (range 1.4–8 kg), respectively. In 10 patients, surgical intervention preceded transcatheter stent placement. Four had complex aortic arch obstruction and seven had recoarctation. Results : Reduction in peak systolic gradient to <10 mm Hg was achieved in seven of 10 patients with an improvement in aortic artery diameter to >90% of adjacent aorta in all. The diameter of the arch obstruction increased from a median of 1.60 to 4.90 mm (P = 0.001) and the peak systolic gradient from 45 mm Hg to 8 mm Hg (P < 0.0001). Adverse events occurred in two patients one who required further surgical revision and a second who required placement of a second stent. The median follow up was 3.60 years (range 0.4–5.5 years) with two patients having died at 1.34 and 1.42 years poststent placement. Of the nine patients alive, six have since undergone further angioplasty at a median time interval of 0.77 years (range 0.17–2.76 years). Long‐term complications occurred in none. Conclusions : Endovascular stent placement in infants is technically feasible with good results achievable even in small babies. It should be considered as a therapeutic option in complex cases when surgical alternatives are less favorable. © 2010 Wiley‐Liss, Inc.     

First‐in‐man use of a tapered endovascular stent graft for treatment of aneurysm after coarctation repair

Objectives : Endovascular stenting of aneurysms late after surgical repair of coarctation may have to deal with marked changes in aortic diameter proximal and distal to the aneurysm. We report our first‐in‐man successful use of a custom‐made tapered (variable diameter) covered stent. Methods : The aneurysm was 42 mm in diameter with a length of 40 mm. On MRI, the aorta measured 19.6 mm proximal and 13.3 mm distal to the aneurysm. The aim was to oversize the stent by 10–20%. A covered Cheatham‐platinum stent was designed so that cranial portion of the stent would expand to 22 mm and the caudal portion to 15 mm with a length of 8.5 cm when fully inflated. The stent was mounted on a balloon‐in‐balloon delivery system and was delivered through an 18 F femoral arterial sheath. Rapid‐pacing technique was used for deployment. Results : The stent was successfully deployed without complications. After deployment, the stent diameter measured 21.2 mm cranially and 15.6 mm caudally. A mild distal endoleak due to inadequate fixation of the stent graft was resolved by post dilation expanding the stent diameter to 22.1 mm and 15.9 mm, respectively. The femoral access site was closed using two percutaneous closure devices and the patient discharged the day after the procedure. Follow‐up CT‐angiography showed continued successful exclusion of the aneurysm. Conclusions : A new custom‐made balloon expandable covered stent‐design enabled successful treatment of an aortic aneurysm. This design may offer greater potential for more favorable initial angiographic results and potentially long‐term outcomes due to superior apposition to the aortic wall. © 2010 Wiley‐Liss, Inc.     

Results of stent implantation for native and recurrent coarctation of the aorta—follow‐up of up to 13 years

Background: To evaluate the mid and long‐term prognosis after stenting of native or recurrent CoA, we studied the cardiovascular parameters in the follow‐up period up to 13 years. Methods and results: Between 1993 and 2006, 68 patients underwent stent implantation for aortic coarctation (average age 25.5 years, range 5.7–65 years, average weight 65.5 kg, range 32–122 kg). Forty‐six (68%) patients were aged >17 years. Stenting was performed for native coarctation in 41 and for recurrent coarctation in 27 patients, in 23 (34%) patients with a covered stent. Redilation was carried out in 26 (38%) patients. The invasive systolic gradient decreased from mean (±SD) 25 (±15) mm Hg to 5 (±5) mm Hg (P < 0.0005). The descending aorta pressure increased from 80 (±15) mm Hg to 101 (±18) mm Hg. The systolic right arm blood pressure decreased from a mean of 153 (±24) mm Hg to 129 (±18) mm Hg (P < 0.0005). Complications like small dissections were rare. Follow‐up (6 days to 13 years, mean 41 months) was available in 66 patients, in 23 after reintervention at a mean of 71 months, range of 8 months to 10.3 years. Fifty‐one percent remained clinically hypertensive. Conclusions: Stenting of aortic coarctation gives good medium‐term results. Frequent reintervention relate to deliberately under‐dilating stents during the initial procedure. The reintervention rate has reduced since the introduction of covered stents. © 2011 Wiley‐Liss, Inc.     

Endovascular stents for treatment of coarctation of the aorta: Acute results and follow‐up experience

Balloon angioplasty as treatment for coarctation of the aorta is increasingly performed. Endovascular stents have been proposed as a means of improving the efficacy and safety of the procedure. In this report, we describe one institution's immediate results and clinical follow‐up after implantation of endovascular stents. Retrospective analysis for endovascular stent placement for coarctation of the aorta between 1993 and 2002 was made. The immediate hemodynamic results and clinical follow‐up were reviewed. Thirty‐two patients underwent attempted stent placement for coarctation. Twenty‐three patients had postoperative recurrent coarctation and nine had native coarctation. The systolic gradient decreased from 31 to 1.8 mm Hg (P = 0.001) and the diameter was increased 8.1 to 13.5 mm (P–0.001). Mean follow‐up was 1.5 years. The mean follow‐up gradient as assessed by sphygomomanometry was 13.1 mm Hg. Eight patients underwent 10 successful further dilations. Complications included one stent migration and one aortic dissection. The use of stents as an adjunct to balloon angioplasty in selected patients with coarctation can be performed with low complication rates and provides excellent immediate relief of obstruction with promising follow‐up. Further dilation of these stents is possible. Long‐term follow‐up is warranted. Catheter Cardiovasc Interv 2004;62:499–505. © 2004 Wiley‐Liss, Inc.     

Usefulness of stenting in aortic coarctation in patients with the Turner syndrome

We report our experience with stent implantation for treatment of aortic coarctation in patients with Turner syndrome. Ten consecutive patients with Turner syndrome and aortic coarctation (median age 12 years, range 9 to 24) underwent coarctation stenting. Of these, 6 patients were treated for isolated coarctation and 4 for recurrent coarctation (3 after balloon dilation and 1 after balloon dilation and surgical repair). Bare metal stents were implanted in 7 patients and covered stents in 3. Immediately after stent implantation, peak systolic gradient decreased from 46.1 ± 24.3 to 1.9 ± 2.1 mm Hg (p <0.001). Aortic diameter at coarctation site increased from 5.1 ± 3.2 to 15.3 ± 2.0 mm after stenting (p <0.001). There were no deaths or procedure-related complications. During a median follow-up of 30.5 months, no patient developed restenosis. Two patients developed late aortic aneurysms at the coarctation site. In conclusion, stent implantation for aortic coarctation in patients with Turner syndrome appears to be a safe and effective alternative to surgical repair. Larger cohorts and longer-term follow-up are required to determine the effects of the procedure on the aortic wall.     

Initial and six-year results of stent implantation for aortic coarctation in children

Although stenting has been used as a treatment option for aortic coarctation (CoA) at increasingly younger ages, limited information is available on the long-term follow-up of stent implantation for CoA in pediatric patients. A total of 74 patients with CoA (mean age 8 ± 3 years) underwent stent implantation; 42 were treated for isolated native CoA and 32 for recurrent CoA. A total of 87 stents were implanted (bare metal stents in 71 patients and covered stents in 3 patients). Redilation of a previously implanted stent was performed in 32 patients. Immediately after stenting, the peak systolic pressure gradient decreased from 68 ± 16 mm Hg to 8 ± 5 mm Hg (p <0.05), and the CoA diameter increased from 5 ± 3 mm to 16 ± 3 mm (p <0.05). The most important procedural complication was aneurysm formation in 1 patient that was successfully treated with implantation of a covered stent. No early or late deaths occurred and no evidence was found of late aneurysm formation during a follow-up period of 6 years. Late stent fracture was observed in 3 patients. At the end of follow-up, no cases of recoarctation were identified on multislice computed tomography or magnetic resonance imaging, and 67 (85%) of the 74 patients were normotensive, receiving no medications. In conclusion, stent implantation is an effective and safe treatment alternative to conventional surgical management for the treatment of CoA in selected pediatric patients.     

Covered Cheatham-platinum stents for aortic coarctation: early and intermediate-term results.

OBJECTIVES: This study sought to evaluate the use of covered Cheatham-platinum (CP) stents in the treatment of aortic coarctation (CoA). BACKGROUND: Aortic aneurysms and stent fractures have been encountered after surgical and transcatheter treatment for CoA. Covered stents have previously been used in the treatment of abdominal and thoracic aneurysms in adults. We implanted covered CP stents as a rescue treatment in patients with CoA aneurysms or previous stent-related complications and in patients at risk of developing complications because of complex CoA anatomy or advanced age. METHODS: Thirty-three covered CP stents were implanted in 30 patients; 16 patients had had previous procedures. The remaining patients had complex or near-atretic CoA. RESULTS: The mean patient age and weight were 28 (+/-17.5) years (range 8 to 65 years), and 62 (+/-13) kg (range 28 to 86 kg), respectively. The systolic gradient across the CoA decreased from a mean (+/-SD) of 36 +/- 20 mm Hg before to a mean of 4 +/- 4 mm Hg after the procedure (p < 0.0001), and the diameter of the CoA increased from 6.4 +/- 3.8 mm to 17.1 +/- 3.1 mm (p < 0.0001). The follow-up period was up to 40 months (mean, 11 months). All stents were patent and in good position on computed tomography or magnetic resonance imaging performed three to six months later. In 43% of the patients antihypertensive medication was either decreased or stopped. CONCLUSIONS: Covered CP stents may be used as the therapy of choice in patients with complications after CoA repairs, whereas they provide a safe alternative to conventional stenting in patients with severe and complex CoA lesions or advanced age.