Long-Term Follow-up after Endovascular Treatment of Aortic Coarctation with Covered and Bare Cheatham Platinum Stent

Background: Endovascular treatment of aortic coarctation in adolescents and adult patients predominantly involves stent implantation. The aim of this study was to analyze long-term results after treatment of coarctation with covered and bare Cheatham-platinum (CP) stents. Primary endpoints were defined as procedural success, survival and reintervention rate. Secondary end-points were periprocedural and long-term complications.

Method: From 1999 to 2021, a total of 212 patients received endovascular treatment of aortic coarctation with covered (n = 144) and bare CP stents (n = 48). Treatment of native coarctation was performed in 140 patients, whereas 72 patients received treatment of re-coarctation after primary surgical repair. Median patient age was 18.8 years (IQR: 11.9; 37.5) and median patient weight 61.6 kg [IQR: 44.0; 74.8]. Long-term follow-up was available in 148 patients with a median follow-up time of 7.8 years (4.8; 12.8).

Results: Procedural success was achieved in 210 of 212 patients. Survival rate of the total cohort was 98.1% after 5 years and 96.2% after 10 years. The survival rate did not differ between patients receiving covered or bare CP stents (log-rank p = 0.48). The probability of freedom from reintervention in the overall cohort was 87.2% after 5 and 70.9% after 10 years, respectively. The reintervention rate (82/212) did not differ between patients who received endovascular treatment using covered or bare CP stents (log-rank p = 0.90) or between patients with native or postsurgical recoarctation (p = 0.54). Periprocedural complications occurred in 15 of 212 patients (injury/thrombosis of vascular access vessel: n = 8; bleeding: n = 1; stent dislocation: n = 3; aortic dissection: n = 3). Long-term complications were observed in 14 of 148 patients and included stent fracture (n = 6), aneurysm formation (n = 5), endoleak (n = 1), and subclavian artery stenosis (n = 2). Periprocedural and long-term complications did not diverge between covered or bare CP stents.

Conclusion: Endovascular treatment of aortic coarctation using CP stents can be performed safely and effectively with excellent long-term results. In our analysis, the use of either covered or bare CP stents was not associated with survival, reintervention, and complication rates in the long term. However, individual stent selection should be performed with regard to the morphology and severity of aortic coarctation as well as patient's age.

Publication History

Article published online:
28 January 2023