Acute and Long-term Outcomes for Recoarctation and Arterial Hypertension in Patients with Stent Therapy of the Aortic Coarctation

Objectives: Stent implantation has become the treatment of choice for native aortic coarctation (CoA) and postsurgical aortic recoarctation (ReCoA) in children, adolescents and adults. However, to date there is limited information of the intermediate and long results following stenting. We evaluated the outcomes of stent implantation for native and ReCoA

Methods: The data of all 218 patients who underwent stent implantation in our hospital between February 1999 and August 2017 were retrospectively analyzed. Hundred patients were diagnosed with native CoA and 118 patients with ReCoA. Median age at intervention was 17 years (range: 6; 62 years); median weight was 63 kg (range: 16–130 kg). From these patients, 4 patients were diagnosed with Turner syndrome. Only dilatable stents to adult size were implanted; covered stents in 77 patients (35%), and bare metal stents in 141 patients (65%).

Results: The median peak invasive systolic pressure gradient declined from 23 mm Hg (range 5–109) to 0 mm Hg (range: 0–50) (p < 0.001). The median minimal diameter of the stenosed aortic segment increased from 8 mm (min. 0; max. 19) to 14 mm (range: 6.2–24) (p < 0.001). There were two cases of aortic ruptures in adults. One patient died during the intervention and one patient was rescued by covered stent implantation. Median follow-up time was median 50 months (range: 1–216 months). One hundred and thirty-five patients (62%) were scheduled for re-catheterization; in 82 patients (38%) a redilatation and in 18 patients (8%) a second stent-implantation was necessary. Data on arterial hypertension is shown in [Table 1].

Conclusion: CoA stenting is an effective means for treatment of native - and ReCoA in children, adolescents and adults. However, up to 46% of these patients need repeated catheterization with balloon angioplasty or a second stent implantation. CoA stenting with proper antihypertensive medications results in better control of blood pressure.

Table 1

Number of patients with	Hypertension and antihypertensive medication	Hypertension without antihypertensive medication	Normotensive and antihypertensive medication	Normotensive without antihypertensive medication
Before CoA Stenting (n = 218)	72 (33%)	105 (48%)	7 (3%)	34 (16%)
After CoA Stenting (n = 176)	26 (15%)	11 (6%)	84 (48%)	55 (31%)