Document Detail

Stenting complex aortic arch obstructions.
MedLine Citation:
PMID:  18288730     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To present our institutional experience of endovascular stent therapy in patients with complex aortic arch lesions. BACKGROUND: The management of aortic arch obstructions is complex and many physicians are either reluctant to treat mild-moderate aortic arch lesions associated with systemic hypertension or instead refer to high-risk surgical alternatives. Reported data on transcatheter stent therapy of complex aortic arch lesions are scarce. METHODS: Between October 2002 and November 2006, 40patients (pts) had complex aortic arch lesions treated with stent implantation in 42 procedures (proc). Aortic arch hypoplasia was present in 30/42 proc (71.4%). The median age was 10 year (16 days - 37 years). In 40/42 proc (95.2%) patients had previous transcatheter or surgical aortic arch interventions. RESULTS: Procedural success in achieving a peak systolic gradient reduction to <or=10 mm Hg with an improvement in the diameter to >or=90% of the "normal" adjacent aortic arch was achieved in 38/42 proc (90.5%). The diameter of the arch obstruction increased from a median of 7.55 mm to a median of 14 mm (P < 0.0001) and the peak systolic gradient was reduced from a median of 23 mm Hg to a median of 2 mm Hg (P < 0.0001). Arch vessels were crossed in 31/42 proc (73.8%). Periprocedural adverse events were encountered in 13/42 proc (30.9%), predominately in patients with a weight below 10 kg or univentricular physiology. The median follow-up was 1 year (32 days - 3.8 years). The incidence of systemic hypertension was significantly reduced from 22/42 (52.4%) before the procedure to 6/39 (15.4%) at the most recent follow-up (P = 0.0005). CT or MRI evaluations were performed in 18 pts, documenting all crossed arch vessels to appear patent. CONCLUSIONS: Stenting of complex aortic arch lesions can be performed safely and effectively with excellent, immediate, and midterm results. Patients with a weight below 10 kg or after Hybrid stage I palliation are at increased risk of adverse events. Stents can be placed across major arch vessels without compromising distal perfusion in otherwise normal vasculature.
Ralf J Holzer; Joanne L Chisolm; Sharon L Hill; John P Cheatham
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions     Volume:  71     ISSN:  1522-726X     ISO Abbreviation:  Catheter Cardiovasc Interv     Publication Date:  2008 Feb 
Date Detail:
Created Date:  2008-02-26     Completed Date:  2008-03-27     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100884139     Medline TA:  Catheter Cardiovasc Interv     Country:  United States    
Other Details:
Languages:  eng     Pagination:  375-82     Citation Subset:  IM    
Copyright Information:
(c) 2008 Wiley-Liss, Inc.
The Heart Center, Columbus Children's Hospital, Columbus, Ohio 43205, USA.
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MeSH Terms
Age Distribution
Angiography / methods
Angioplasty, Balloon / methods*
Aortic Coarctation / diagnosis*,  epidemiology,  therapy*
Child, Preschool
Echocardiography, Doppler
Follow-Up Studies
Heart Catheterization
Infant, Newborn
Risk Assessment
Severity of Illness Index
Sex Distribution
Treatment Outcome

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