Intermediate follow-up following intravascular stenting for treatment of coarctation of the aorta

Thomas J. Forbes, Phillip Moore, Carlos A.C. Pedra, Evan M. Zahn, David Nykanen, Zahid Amin, Swati Garekar, David Teitel, Shakeel A. Qureshi, John P. Cheatham, Makram R. Ebeid, Ziyad M. Hijazi, Satinder Sandhu, Donald J. Hagler, Horst Sievert, Thomas E. Fagan, Jeremy Ringwald, Wei Du, Liwen Tang, David F. WaxJohn Rhodes, Troy A. Johnston, Thomas K. Jones, Daniel R. Turner, Robert Pass, Alejandro Torres, William E. Hellenbrand

Research output: Contribution to journalArticle

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Abstract

Background: We report a multiinstitutional study on intermediate-term outcome of intravascular stenting for treatment of coarctation of the aorta using integrated arch imaging (IAI) techniques. Methods and Results: Medical records of 578 patients from 17 institutions were reviewed. A total of 588 procedures were performed between May 1989 and Aug 2005. About 27% (160/588) procedures were followed up by further IAI of their aorta (MRI/CT/repeat cardiac catheterization) after initial stent procedures. Abnormal imaging studies included: the presence of dissection or aneurysm formation, stent fracture, or the presence of reobstruction within the stent (instent restenosis or significant intimal build-up within the stent). Forty-one abnormal imaging studies were reported in the intermediate follow-up at median 12 months (0.5-92 months). Smaller postintervention of the aorta (CoA) diameter and an increased persistent systolic pressure gradient were associated with encountering abnormal follow-up imaging studies. Aortic wall abnormalities included dissections (n = 5) and aneurysm (n = 13). The risk of encountering aortic wall abnormalities increased with larger percent increase in CoA diameter poststent implant, increasing balloon/coarc ratio, and performing prestent angioplasty. Stent restenosis was observed in 5/6 parts encountering stent fracture and neointimal buildup (n = 16). Small CoA diameter poststent implant and increased poststent residual pressure gradient increased the likelihood of encountering instent restenosis at intermediate follow-up. Conclusions: Abnormalities were observed at intermediate follow-up following IS placement for treatment of native and recurrent coarctation of the aorta. Not exceeding a balloon:coarctation ratio of 3.5 and avoidance of prestent angioplasty decreased the likelihood of encountering an abnormal follow-up imaging study in patients undergoing intravascular stent placement for the treatment of coarctation of the aorta. We recommend IAI for all patients undergoing IS placement for treatment of CoA.

Original languageEnglish (US)
Pages (from-to)569-577
Number of pages9
JournalCatheterization and Cardiovascular Interventions
Volume70
Issue number4
DOIs
StatePublished - Oct 1 2007

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Aortic Coarctation
Stents
Coenzyme A
Angioplasty
Therapeutics
Aneurysm
Aorta
Dissection
Tunica Intima
Cardiac Catheterization
Medical Records
Blood Pressure
Pressure

Keywords

  • Coarctation
  • Intermediate complications
  • Intravascular stent

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Intermediate follow-up following intravascular stenting for treatment of coarctation of the aorta. / Forbes, Thomas J.; Moore, Phillip; Pedra, Carlos A.C.; Zahn, Evan M.; Nykanen, David; Amin, Zahid; Garekar, Swati; Teitel, David; Qureshi, Shakeel A.; Cheatham, John P.; Ebeid, Makram R.; Hijazi, Ziyad M.; Sandhu, Satinder; Hagler, Donald J.; Sievert, Horst; Fagan, Thomas E.; Ringwald, Jeremy; Du, Wei; Tang, Liwen; Wax, David F.; Rhodes, John; Johnston, Troy A.; Jones, Thomas K.; Turner, Daniel R.; Pass, Robert; Torres, Alejandro; Hellenbrand, William E.

In: Catheterization and Cardiovascular Interventions, Vol. 70, No. 4, 01.10.2007, p. 569-577.

Research output: Contribution to journalArticle

Forbes, TJ, Moore, P, Pedra, CAC, Zahn, EM, Nykanen, D, Amin, Z, Garekar, S, Teitel, D, Qureshi, SA, Cheatham, JP, Ebeid, MR, Hijazi, ZM, Sandhu, S, Hagler, DJ, Sievert, H, Fagan, TE, Ringwald, J, Du, W, Tang, L, Wax, DF, Rhodes, J, Johnston, TA, Jones, TK, Turner, DR, Pass, R, Torres, A & Hellenbrand, WE 2007, 'Intermediate follow-up following intravascular stenting for treatment of coarctation of the aorta', Catheterization and Cardiovascular Interventions, vol. 70, no. 4, pp. 569-577. https://doi.org/10.1002/ccd.21191
Forbes, Thomas J. ; Moore, Phillip ; Pedra, Carlos A.C. ; Zahn, Evan M. ; Nykanen, David ; Amin, Zahid ; Garekar, Swati ; Teitel, David ; Qureshi, Shakeel A. ; Cheatham, John P. ; Ebeid, Makram R. ; Hijazi, Ziyad M. ; Sandhu, Satinder ; Hagler, Donald J. ; Sievert, Horst ; Fagan, Thomas E. ; Ringwald, Jeremy ; Du, Wei ; Tang, Liwen ; Wax, David F. ; Rhodes, John ; Johnston, Troy A. ; Jones, Thomas K. ; Turner, Daniel R. ; Pass, Robert ; Torres, Alejandro ; Hellenbrand, William E. / Intermediate follow-up following intravascular stenting for treatment of coarctation of the aorta. In: Catheterization and Cardiovascular Interventions. 2007 ; Vol. 70, No. 4. pp. 569-577.
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T1 - Intermediate follow-up following intravascular stenting for treatment of coarctation of the aorta

AU - Forbes, Thomas J.

AU - Moore, Phillip

AU - Pedra, Carlos A.C.

AU - Zahn, Evan M.

AU - Nykanen, David

AU - Amin, Zahid

AU - Garekar, Swati

AU - Teitel, David

AU - Qureshi, Shakeel A.

AU - Cheatham, John P.

AU - Ebeid, Makram R.

AU - Hijazi, Ziyad M.

AU - Sandhu, Satinder

AU - Hagler, Donald J.

AU - Sievert, Horst

AU - Fagan, Thomas E.

AU - Ringwald, Jeremy

AU - Du, Wei

AU - Tang, Liwen

AU - Wax, David F.

AU - Rhodes, John

AU - Johnston, Troy A.

AU - Jones, Thomas K.

AU - Turner, Daniel R.

AU - Pass, Robert

AU - Torres, Alejandro

AU - Hellenbrand, William E.

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N2 - Background: We report a multiinstitutional study on intermediate-term outcome of intravascular stenting for treatment of coarctation of the aorta using integrated arch imaging (IAI) techniques. Methods and Results: Medical records of 578 patients from 17 institutions were reviewed. A total of 588 procedures were performed between May 1989 and Aug 2005. About 27% (160/588) procedures were followed up by further IAI of their aorta (MRI/CT/repeat cardiac catheterization) after initial stent procedures. Abnormal imaging studies included: the presence of dissection or aneurysm formation, stent fracture, or the presence of reobstruction within the stent (instent restenosis or significant intimal build-up within the stent). Forty-one abnormal imaging studies were reported in the intermediate follow-up at median 12 months (0.5-92 months). Smaller postintervention of the aorta (CoA) diameter and an increased persistent systolic pressure gradient were associated with encountering abnormal follow-up imaging studies. Aortic wall abnormalities included dissections (n = 5) and aneurysm (n = 13). The risk of encountering aortic wall abnormalities increased with larger percent increase in CoA diameter poststent implant, increasing balloon/coarc ratio, and performing prestent angioplasty. Stent restenosis was observed in 5/6 parts encountering stent fracture and neointimal buildup (n = 16). Small CoA diameter poststent implant and increased poststent residual pressure gradient increased the likelihood of encountering instent restenosis at intermediate follow-up. Conclusions: Abnormalities were observed at intermediate follow-up following IS placement for treatment of native and recurrent coarctation of the aorta. Not exceeding a balloon:coarctation ratio of 3.5 and avoidance of prestent angioplasty decreased the likelihood of encountering an abnormal follow-up imaging study in patients undergoing intravascular stent placement for the treatment of coarctation of the aorta. We recommend IAI for all patients undergoing IS placement for treatment of CoA.

AB - Background: We report a multiinstitutional study on intermediate-term outcome of intravascular stenting for treatment of coarctation of the aorta using integrated arch imaging (IAI) techniques. Methods and Results: Medical records of 578 patients from 17 institutions were reviewed. A total of 588 procedures were performed between May 1989 and Aug 2005. About 27% (160/588) procedures were followed up by further IAI of their aorta (MRI/CT/repeat cardiac catheterization) after initial stent procedures. Abnormal imaging studies included: the presence of dissection or aneurysm formation, stent fracture, or the presence of reobstruction within the stent (instent restenosis or significant intimal build-up within the stent). Forty-one abnormal imaging studies were reported in the intermediate follow-up at median 12 months (0.5-92 months). Smaller postintervention of the aorta (CoA) diameter and an increased persistent systolic pressure gradient were associated with encountering abnormal follow-up imaging studies. Aortic wall abnormalities included dissections (n = 5) and aneurysm (n = 13). The risk of encountering aortic wall abnormalities increased with larger percent increase in CoA diameter poststent implant, increasing balloon/coarc ratio, and performing prestent angioplasty. Stent restenosis was observed in 5/6 parts encountering stent fracture and neointimal buildup (n = 16). Small CoA diameter poststent implant and increased poststent residual pressure gradient increased the likelihood of encountering instent restenosis at intermediate follow-up. Conclusions: Abnormalities were observed at intermediate follow-up following IS placement for treatment of native and recurrent coarctation of the aorta. Not exceeding a balloon:coarctation ratio of 3.5 and avoidance of prestent angioplasty decreased the likelihood of encountering an abnormal follow-up imaging study in patients undergoing intravascular stent placement for the treatment of coarctation of the aorta. We recommend IAI for all patients undergoing IS placement for treatment of CoA.

KW - Coarctation

KW - Intermediate complications

KW - Intravascular stent

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