Covered Cheatham-Platinum Stents for Serial Dilation of Severe Native Aortic Coarctation

Objectives: To report on the early results of treatment of native coarctation of the aorta by implantation and serial dilations of covered stents. Background: Transcatheter dilation of native coarctation of the aorta carries a risk of aneurysm or rupture. Covered stent implantation requires a large delivery system with the risk of vascular damage. Methods: Covered stents on balloons of diameter sufficient to anchor the stent in the coarctation were implanted using the smallest delivery system possible. Dilation with larger diameter balloons was performed until the pressure gradient was <20 mm Hg and the stent was opposed to the aortic wall. Results: Twenty-two patients with native coarctation underwent stent implantation. Coarctation diameter increased from 3.6 +/- 1.9 to 12.6 +/- 1.9 mm (P < 0.001). Peak pressure gradient decreased from 29.4 +/- 8.5 to 6.7 +/- 5.7 mm Hg (P < 0.001). Nine patients underwent further dilation on average 5 months later. Residual pressure gradient decreased from 12.3 +/- 5.8 to 2.1 +/- 2.9 mm Hg (P = 0.002). The stent achieved the diameter of the transverse arch in all cases. Complications included a small tear at further dilation treated with a second stent and a femoral pseudoaneurysm. At short-term follow-up of 18.5 months all patients are alive and well with no evidence of recoarctation or aneurysm. Conclusions: These initial results show that serial dilation of covered Cheatham-Platinum stents is feasible, safe, and an effective percutaneous method for the treatment of native coarctation of the aorta. However, long-term follow up is required. (C) 2009 Wiley-Liss, Inc.