Original title: Percutaneous treatment of adult isthmic aortic coarctation: acute and long-term clinical and imaging outcome with a self-expandable uncovered nitinol stent. Reference: Kische S et al. Circ Cardiovasc Interv. 2015 Jan;8(1).
The aim of this study was to show perioperative and long term results of the percutaneous treatment of aortic coarctation with the self-expandable uncovered nitinol stent (Sinus-XL, Optimed, Esslingen, Germany).
A total of 52 consecutive patients were treated with this device. Mean age was 36.6 and peak invasive trans-coarctation was 54.7±9.9 mm Hg. All patients presented upper body hypertension unresponsive to medical treatment.
Mean stent diameter was 24.2 mm (22-28mm) and mean length was 70.4 mm (40-80 mm). 8 patients required pre dilatation (15.4%) and post dilatation with noncompliant balloon. Postoperative peak gradient was 3.3 ± 2.5 mm Hg, significantly reduced compared to preoperative peak gradient (p<0.001). All patients were discharged at 3.5 days, in average. At 47.6 month follow up, a patients died for non-cardiovascular cause.
Aortic computed tomography confirmed the absence of stent collapse and migration, as well as the stability of the maximum aortic diameter obtained immediately after procedure. More than half of patients (57.7%) were completely weaned-off antihypertensive medications and the rest used significantly less, with an ankle-brachial pressure index increase from 75 to 0.98 (p<0.001).
Conclusion
The treatment of aortic coarctation in adult patients with a self-expandable uncovered stent is safe and durable. Stent design maintains an adequate radial strength over time with minimal trauma to the aortic wall and no stent-related complications. Hypertension control is immediate and persists over time.
Editorial Comment
In many countries, this kind of treatment is done with PTFE covered self-expandable balloon stents to prevent rupture after dilation of coarctation, which has not happened to any patient enrolled in this trial, so far. Perhaps, the fact that the device used is self-expandable allows a more controlled dilation and prevents complications.
SOLACI
