EFFECTIVENESS OF COVERED Cheatham-platinum STENT FOR TREATMENT OF COARCTATION OF AORTA_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

JIASenhao ¹ , DUANChen ² ,  GUOWei ¹ , JIAXin ¹ , XIONGJiang ¹ , XUYongle ¹ , LIUJie ¹ , ZHANGTao ¹ , SONGYuxiang ¹

1. Department of Vascular Surgery, General Hospital of Chinese PLA, Beijing, 100853, P. R. China;
2. Medical College of Nankai University;

Corresponding author：

GUOWei, Email: pla301dml@vip.sina.com

Keywords：

Coarctation of aorta; Covered stent; Endovascular interventional treatment; Complication

DOI：

10.7507/1002-1892.20140113

Video：

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Objective To evaluate the effectiveness of covered Cheatham-platinum (CP) stent for treatment of coarctation of aorta (CoA). Methods Between January 2007 and September 2013, 15 patients (16 lesions) with CoA underwent covered CP stent implantation, and the clinical data were analyzed retrospectively. Of 15 cases, 8 were male and 7 were female, aged 13-56 years (mean, 27.7 years). Fifteen lesions located beyond the origin of the left subdavian artery, and 1 lesion located between the origin of the left common carotid artery and the origin of the left subdavian artery. Proper covered CP stent and balloon-in-balloon (BIB) catheter were selected according to the data of computed tomography angiography or digital subtraction angiography examination. Under fluoroscopic guidance, the covered CP stent was placed at lesion accurately by expanding the inner balloon and the outer balloon sequentially. The variation of the systolic pressure gradient across the lesion and the stenosis extent of the aorta before and after the procedure were recorded. Results Fifteen patients were all treated by covered CP stent implantation successfully. The systolic pressure gradient across the lesion decreased from (58.1±19.5) mm Hg (1 mm Hg=0.133 kPa) at preoperation to (6.2±5.6) mm Hg at immediate after CP stent implantation, and the stenosis extent of the aorta decreased from 73.8%±12.8% at preoperation to 16.7%±5.6% at immediate after CP stent implantation, all showing significant difference (t=12.483, P=0.000; t=15.631, P=0.000). All puncture points healed well with no aortic dissection, pseudoaneurysm, or obvious subcutaneous hematoma. All the patients could walk moderately within 48 hours after procedure. The average hospitalization time was 11.1 days (range, 6-18 days). During a mean follow-up of 29.7 months (range, 1-81 months), the symptom of dizziness and exercise tolerance were improved obviously, and the systolic pressures gradient between upper and lower extremity was below 20 mm Hg. The systolic and diastolic pressures at last follow-up were significantly improved when compared with preoperative values (t=7.725, P=0.000; t=3.651, P=0.000). According to radiography, the location and shape of the stent were good, and no aortic dissection, aneurysm, or recoarctation occurred. Conclusion According to the initial and midterm results, the covered CP stent is an effective treatment for CoA in adolescents and adults with a low rate of complication. However, long-term results still require further follow-up.

Citation： JIASenhao, DUANChen, GUOWei, JIAXin, XIONGJiang, XUYongle, LIUJie, ZHANGTao, SONGYuxiang. EFFECTIVENESS OF COVERED Cheatham-platinum STENT FOR TREATMENT OF COARCTATION OF AORTA. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(4): 503-506. doi: 10.7507/1002-1892.20140113 Copy

1.	Rao PS. Coarctation of the aorta. Semin Nephrol, 1995, 15(2):87-105.
2.	Tanous D, Benson LN, Horlick EM. Coarctation of the aorta:evaluation and management. Curr Opin Cardiol, 2009, 24(6):509-515.
3.	Kische S, Schneider H, Akin I, et al. Technique of interventional repair in adult aortic coarctation. J Vasc Surg, 2010, 51(6):1550-1559.
4.	Jurcut R, Daraban AM, Lorber A, et al. Coarctation of the aorta in adults:what is the best treatment? Case report and literature review. J Med Life, 2011, 4(2):189-195.
5.	Singer MI, Rowen M, Dorsey TJ. Transluminal aortic balloon angioplasty for coarctation of the aorta in the newborn. Am Heart J, 1982, 103(1):131-132.
6.	Brown SC, Bruwer AD. Balloon angioplasty of native coarctation of the aorta in a local group of children:acute results and midterm angiographic re-assessment. Cardiovasc J S Afr, 2003, 14(4):177-181.
7.	Parra-Bravo JR, Reséndiz-Balderas M, Francisco-Candelario R, et al. Balloon angioplasty for native aortic coarctation in children younger than 12 months:immediate and medium-term results. Arch Cardiol Mex, 2007, 77(3):217-225.
8.	Thanopoulos BD, Giannakoulas G, Giannopoulos A, et al. Initial and six-year results of stent implantation for aortic coarctation in children. Am J Cardiol, 2012, 109(10):1499-1503.
9.	Qureshi AM, McElhinney DB, Lock JE, et al. Acute and intermediate outcomes, and evaluation of injury to the aortic wall, as based on 15 years experience of implanting stents to treat aortic coarctation. Cardiol Young, 2007, 17(3):307-318.
10.	Varma C, Benson LN, Butany J, et al. Aortic dissection after stent dilatation for coarctation of the aorta:a case report and literature review. Catheter Cardiovasc Interv, 2003, 59(4):528-535.
11.	Sadiq M, Ur Rehman A, Qureshi AU, et al. Covered stents in the management of native coarctation of the Aorta-Intermediate and long-term follow-up. Catheter Cardiovasc Interv, 2013, 82(4):511-518.
12.	韩晓峰, 黄小勇, 郭曦, 等. 覆膜CP支架治疗主动脉缩窄的临床应用研究. 心肺血管病杂志, 2013, 32(4):414-417.
13.	熊江, 郭伟, 刘小平, 等. 覆膜Cheatham-Platinum支架治疗主动脉缩窄九例早中期结果. 中华外科杂志, 2012, 50(7):629-632.
14.	Butera G, Gaio G, Carminati M. Redilation of e-PTFE covered CP stents. Catheter Cardiovasc Interv, 2008, 72(2):273-277.
15.	黄连军, 俞飞成, 蒋世良, 等. 覆膜Cheatham Platinum支架置入治疗主动脉缩窄的疗效评价. 中华放射学杂志, 2006, 40(11):1195-1196.
16.	Tzifa A, Ewert P, Brzezinska-Rajszys G, et al. Covered Cheatham-platinum stents for aortic coarctation:early and intermediate-term results. J Am Coll Cardiol, 2006, 47(7):1457-1463.
17.	Bruckheimer E, Dagan T, Amir G, et al. Covered Cheatham-Platinum stents for serial dilation of severe native aortic coarctation. Catheter Cardiovasc Interv, 2009, 74(1):117-123.
18.	俞飞成, 黄连军, 吴文辉, 等. 带膜支架置入治疗主动脉缩窄合并动脉导管未闭一例. 中华心血管病杂志, 2006, 34(4):563.

1. Rao PS. Coarctation of the aorta. Semin Nephrol, 1995, 15(2):87-105.
2. Tanous D, Benson LN, Horlick EM. Coarctation of the aorta:evaluation and management. Curr Opin Cardiol, 2009, 24(6):509-515.
3. Kische S, Schneider H, Akin I, et al. Technique of interventional repair in adult aortic coarctation. J Vasc Surg, 2010, 51(6):1550-1559.
4. Jurcut R, Daraban AM, Lorber A, et al. Coarctation of the aorta in adults:what is the best treatment? Case report and literature review. J Med Life, 2011, 4(2):189-195.
5. Singer MI, Rowen M, Dorsey TJ. Transluminal aortic balloon angioplasty for coarctation of the aorta in the newborn. Am Heart J, 1982, 103(1):131-132.
6. Brown SC, Bruwer AD. Balloon angioplasty of native coarctation of the aorta in a local group of children:acute results and midterm angiographic re-assessment. Cardiovasc J S Afr, 2003, 14(4):177-181.
7. Parra-Bravo JR, Reséndiz-Balderas M, Francisco-Candelario R, et al. Balloon angioplasty for native aortic coarctation in children younger than 12 months:immediate and medium-term results. Arch Cardiol Mex, 2007, 77(3):217-225.
8. Thanopoulos BD, Giannakoulas G, Giannopoulos A, et al. Initial and six-year results of stent implantation for aortic coarctation in children. Am J Cardiol, 2012, 109(10):1499-1503.
9. Qureshi AM, McElhinney DB, Lock JE, et al. Acute and intermediate outcomes, and evaluation of injury to the aortic wall, as based on 15 years experience of implanting stents to treat aortic coarctation. Cardiol Young, 2007, 17(3):307-318.
10. Varma C, Benson LN, Butany J, et al. Aortic dissection after stent dilatation for coarctation of the aorta:a case report and literature review. Catheter Cardiovasc Interv, 2003, 59(4):528-535.
11. Sadiq M, Ur Rehman A, Qureshi AU, et al. Covered stents in the management of native coarctation of the Aorta-Intermediate and long-term follow-up. Catheter Cardiovasc Interv, 2013, 82(4):511-518.
12. 韩晓峰, 黄小勇, 郭曦, 等. 覆膜CP支架治疗主动脉缩窄的临床应用研究. 心肺血管病杂志, 2013, 32(4):414-417.
13. 熊江, 郭伟, 刘小平, 等. 覆膜Cheatham-Platinum支架治疗主动脉缩窄九例早中期结果. 中华外科杂志, 2012, 50(7):629-632.
14. Butera G, Gaio G, Carminati M. Redilation of e-PTFE covered CP stents. Catheter Cardiovasc Interv, 2008, 72(2):273-277.
15. 黄连军, 俞飞成, 蒋世良, 等. 覆膜Cheatham Platinum支架置入治疗主动脉缩窄的疗效评价. 中华放射学杂志, 2006, 40(11):1195-1196.
16. Tzifa A, Ewert P, Brzezinska-Rajszys G, et al. Covered Cheatham-platinum stents for aortic coarctation:early and intermediate-term results. J Am Coll Cardiol, 2006, 47(7):1457-1463.
17. Bruckheimer E, Dagan T, Amir G, et al. Covered Cheatham-Platinum stents for serial dilation of severe native aortic coarctation. Catheter Cardiovasc Interv, 2009, 74(1):117-123.
18. 俞飞成, 黄连军, 吴文辉, 等. 带膜支架置入治疗主动脉缩窄合并动脉导管未闭一例. 中华心血管病杂志, 2006, 34(4):563.

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EFFECTIVENESS OF COVERED Cheatham-platinum STENT FOR TREATMENT OF COARCTATION OF AORTA

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