Balloon dilatation and stent implantation for vascular stenosis

BACKGROUND: Previous results show that the success rate of balloon angioplasty for pulmonary artery stenosis is low. Mortality and morbidity are significant in balloon angioplasty for coarctation of the aorta. METHODS: A review of the experience of balloon angioplasty for pulmonary artery stenosis and coarctation of the aorta at our institution was performed. A review of scientific reports of balloon angioplasty for these lesions was investigated. RESULTS: Review of our results indicates that balloon angioplasty for pulmonary artery stenosis can be performed with a high success rate (80-90%), (i) by performing it at an appropriate time, (ii) by using high-pressure balloons, (iii) by using stents, and (iv) by using intravascular ultrasound (IVUS). Major complications occurred in 3% at our institution in balloon angioplasty for pulmonary artery stenosis. Incomplete dilation has been noted in 10-25% of patients of coarctation of the aorta. Aortic aneurysm has been reported in 2-7% of patients. Re-stenosis and/or hypertension also occur. The re-stenosis rate may be decreased if the aorta is dilated until signs of intimal tear are observed. Systemic hypertension may be noted in the long term after balloon angioplasty of coarctation of the aorta, even in patients with fairly good anatomical repair. The mechanisms for hypertension are not clear, but residual stenosis, even mild, may result in upper body hypertension. CONCLUSIONS: Although there are significant limitations in the procedures, balloon angioplasty is effective in the management of pulmonary artery stenosis and coarctation of the aorta.