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Endovascular Management Of Aortic Coarctation Using Innovative Stent Technology
Peter Foster, DO, Ivory Crittendon, III, MD, Samuel Money, MD.
Ochsner, New Orleans, LA, LA, USA.
OBJECTIVES: Aortic coarctation (AC) is a congenital defect characterized by a narrowing of the descending thoracic aorta near the left subclavian artery. Currently, there are surgical and endovascular treatments available. For adolescents and adults, balloon angioplasty and stenting are indicated. However, up to 10% of patients treated with off-label commercial endografts experience complications such as aortic dissection, rupture, or embolization. The Cheatham-Platinum (CP) stent graft is a balloon expandable ePTFE covered platinum skeleton endograft that is delivered on a balloon-in-a-balloon catheter, a technology with specific indication for aortic coarctation. This design allows for safe and precise deployment. The procedure begins by inflating the inner, low-profile balloon to secure the stent at the coarctation site, followed by expansion of the outer, larger balloon to complete the deployment. This sequence reduces risks of asymmetric stent expansion, migration, or "watermelon seeding," ensuring a secure fit.
METHODS: This report is a single-center retrospective review of 10 consecutive patients (five female) treated for AC. Patient cohort consisted of older adolescents and adults (x= 28 years +/- 5.6, 13-62). Primary indications for intervention were upper extremity hypertension (7 patients), pseudoaneurysm (1), aortic insufficiency (1), and claudication (1). Five patients had prior intervention of their coarctation (3 open repair, 2 off-label aortic endografts). Rapid ventricular pacing was used for all deployments.
RESULTS: Mean lengths of treated lesions were 5.4 mm +/- 1.8 with mean aortic diameters of 7.6 mm +/- 1.2 located 26.1 mm +/- 3.95 from coarctation to the left subclavian artery. Technical success was reported in all 10 patients, which was judged on mean improvement of pre gradient mean arterial pressure of 33.6 mmHg +/- 9.1 to < 5 mmHg in all cases. Among patients with hypertension, six out of seven required a reduced number of antihypertensive medications. No adverse events were reported. The median length of stay was 1.0 day. Mean follow up was 25.3 months +/- 7.55 with no recurrences. The list price of this device is less than half of standard thoracic endografts.
CONCLUSIONS: This series demonstrates that balloon expandable covered stent graft using balloon-in-a-balloon technology was a safe, effective, and economical option for treatment of AC in these 10 patients with recurrent or de novo diagnosed coarctation. Expanded indications of this device are likely feasible.
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