Long-Term Stenting of Aortic Coarctation Yields 77% Success Rate

October 1, 2010—The Society for Cardiovascular and Angiographic Interventions (SCAI) announced that investigators from the Congenital Cardiovascular Interventional Study Consortium (CCISC) who evaluated the results of stent implantation for aortic coarctation found that cumulative intermediate success was 86%, and cumulative long-term success was 77%. Ralf Holzer, MD, et al published the results of this study in Catheterization and Cardiovascular Interventions (2010;76:553–563).

According to SCAI, the investigators report on the procedural success of stent implantation for aortic coarctation, including recurrent obstruction/repeat interventions and aortic wall complications, with a particular focus on intermediate and long-term outcomes.

“This study is the largest series reported to date on stent implantation for aortic coarctation,” commented Dr. Holzer. “It is the only prospective series that includes intermediate as well as long-term follow-up with integrated imaging provided by catheterization, CT, or MRI.”

The study evaluated 302 patients from 34 centers from the CCISC, a prospective interventional registry that captures all types of treatment for coarctation. Patients underwent stent placement for aortic coarctation during a 9-year period between December 2000 and November 2009. Collected data included procedural, demographic, morphological, imaging, and clinical data.

Clinical data were collected at baseline, before discharge, and at follow-up. The data included upper and lower extremity systolic/diastolic blood pressure, as well as the need for antihypertensive medication. Valid follow-up data included integrated imaging data provided by CT and/or MRI and/or cardiac catheterization. All baseline and follow-up imaging data were evaluated for the presence of aortic wall injury (dissection and aneurysm), stent-related pathology (intimal proliferation and stent fracture), and recurrent/residual obstruction.

The investigators reported that 44% of patients completed intermediate follow-up (3–18 months) with integrated imaging, and 21% completed long-term follow-up (> 18–60 months). Acute procedural success was 96%. Acute, intermediate, and long-term procedural success was unrelated to patient weight, presence of transverse arch hypoplasia, use of compliance testing, stent type, and balloon type. Unplanned repeat interventions were required in 4% of patients, and aortic wall complications were seen in 1% of patients. Other adverse events occurred mainly acutely and included technical complications such as stent malposition. At long-term follow-up, 23% of patients continued to have systolic blood pressure above the 95th percentile, 9% had an upper-to-lower limb blood pressure gradient in excess of 20 mm Hg, and 32% were taking antihypertensive medication.

“With a long-term procedural success of 77%, an incidence of aortic wall complications of 1.3%, and a need for unplanned reintervention of 4%, the results of stent implantation compare well with other surgical and interventional series,” concluded Dr. Holzer. “However, even with successful initial stent therapy, patients continue to require long-term follow-up.”