Seguimiento a muy largo plazo tras implante de stent en la coartación de aorta / Very long-term follow-up after aortic stenting for coarctation of the aorta

Introducción y objetivos: El implante de stent es el tratamiento de elección en niños mayores y adultos con coartación aórtica (CoA). El objetivo fue determinar la incidencia de eventos tardíos después del tratamiento con stent. Métodos: Se analizó una cohorte de pacientes con CoA tratados en el centro entre 1993 y 2018 a los que se siguió periódicamente, incluyendo evaluación mediante tomografía computarizada (TC) y fluoroscopia. Resultados: Se incluyó a 167 pacientes con TC y fluoroscopia: 83 (49,7%) ≤ 12 años y 46 (28%) mujeres. El tiempo medio de seguimiento clínico fue de 17±8 años (rango 4-30) y de 11±7 años hasta la TC/fluoroscopia. Se detectó aneurisma en un 13% y se asoció al stent PALMAZ (OR=3,09; IC95%, 1,11-9,49; p=0,036) y a la longitud del stent (OR=0,94; IC95%, 0,89-0,99; p=0,039). La fractura del stent fue frecuente (34%) pero no asociada a la presencia de aneurisma. Se asoció con edad joven (OR=3,57; IC95%, 1,54-8,33; p=0,003), sexo masculino (OR=4,00; IC95%, 1,51-12,50; p=0,008) e inversamente con el stent PALMAZ (OR=0,29; IC95%, 0,12-0,67; p=0,005). La reintervención fue menor en adultos (10%), principalmente por aneurismas. Los pacientes que recibieron tratamiento cuando tenían 12 años o menos presentaron tasas de reintervención más altas (43%) debido al crecimiento somático. Conclusiones: Se observó una incidencia notable de eventos tardíos a largo plazo en pacientes con CoA tratados mediante stent. La reintervención fue más frecuente en pacientes tratados a edades más jóvenes. Parece aconsejable una vigilancia periódica mediante pruebas de imagen. (AU)

Introduction and objectives: Stent implantation is the preferred treatment in older children and adults with aortic coarctation (CoA). We aimed to determine the incidence of very late events after CoA stenting. Methods: We analyzed a cohort of CoA patients who underwent stent implantation at our center between 1993 and 2018. Patients were periodically followed up in outpatient clinics, including computed tomography (CT) and fluoroscopy assessment. Results: A total of 167 patients with CT and fluoroscopy data were included: 83 (49.7%) were aged ≤ 12 years and 46 (28%) were female. The mean clinical follow-up time was 17±8 (range 4-30) years and the mean time to CT/fluoroscopy was 11±7 years. Aortic aneurysm was present in 13% and was associated with the PALMAZ stent (OR, 3.09; 95%CI, 1.11-9.49; P=.036) and the stented length (OR, 0.94; 95%CI, 0.89-0.99; P=.039). Stent fracture was frequent (34%), but was not related to the presence of aneurysm. Stent fracture was associated with young age (OR, 3.57; 95%CI, 1.54-8.33; P=.003), male sex (OR, 4.00; 95%CI, 1.51-12.5, P=.008) and inversely with the PALMAZ stent (OR, 0.29; 95%CI, 0.12-0.67, P=.005). Reintervention was lower in adults (10%), mainly related to aneurysms. Those treated when aged ≤ 12 years had higher reintervention rates (43%) due to recoarctation somatic growth. Conclusions: This long-term follow-up study of CoA patients treated with stenting revealed a significant incidence of late events. Reintervention rates were higher in patients treated at younger ages. Periodic imaging surveillance appears to be advisable. (AU)

Very long-term follow-up after aortic stenting for coarctation of the aorta.

INTRODUCTION AND OBJECTIVES: Stent implantation is the preferred treatment in older children and adults with aortic coarctation (CoA). We aimed to determine the incidence of very late events after CoA stenting. METHODS: We analyzed a cohort of CoA patients who underwent stent implantation at our center between 1993 and 2018. Patients were periodically followed up in outpatient clinics, including computed tomography (CT) and fluoroscopy assessment. RESULTS: A total of 167 patients with CT and fluoroscopy data were included: 83 (49.7%) were aged ≤ 12 years and 46 (28%) were female. The mean clinical follow-up time was 17±8 (range 4-30) years and the mean time to CT/fluoroscopy was 11±7 years. Aortic aneurysm was present in 13% and was associated with the PALMAZ stent (OR, 3.09; 95%CI, 1.11-9.49; P=.036) and the stented length (OR, 0.94; 95%CI, 0.89-0.99; P=.039). Stent fracture was frequent (34%), but was not related to the presence of aneurysm. Stent fracture was associated with young age (OR, 3.57; 95%CI, 1.54-8.33; P=.003), male sex (OR, 4.00; 95%CI, 1.51-12.5, P=.008) and inversely with the PALMAZ stent (OR, 0.29; 95%CI, 0.12-0.67, P=.005). Reintervention was lower in adults (10%), mainly related to aneurysms. Those treated when aged ≤ 12 years had higher reintervention rates (43%) due to recoarctation somatic growth. CONCLUSIONS: This long-term follow-up study of CoA patients treated with stenting revealed a significant incidence of late events. Reintervention rates were higher in patients treated at younger ages. Periodic imaging surveillance appears to be advisable.

Percutaneous reintervention on aortic coarctation stenting.

AIMS: The aim of this study was to assess the efficacy and safety of percutaneous reintervention in patients who underwent aortic coarctation stenting at an early age. METHODS AND RESULTS: From 1993 to 2018, 177 patients with aortic coarctation were treated with stent implantation at our centre; 33 of them were treated at less than 12 years of age and required reintervention because of their rate of growth. The average age of the patients at the first and second procedure was 6±3 years and 19±7 years, respectively. At the reintervention procedure, 15 (45%) patients were treated with balloon re-expansion, and 18 (55%) were treated with re-stenting. Success was obtained in 30 patients (91%). The gradient across the coarctation changed from 22±10 mmHg to 6±6 mmHg, while the minimal lumen diameter increased from 9±6 mm to 15±3 mm. There were eight occlusions of the femoral artery (after the first procedure), and two covered stents were needed because of femoral bleeding. The mean follow-up time after the second procedure was 5±4 years. A third procedure was required only in three patients (9%). CONCLUSIONS: Patients with aortic coarctation treated with stent placement at an early age can be successfully re-treated after the completion of their somatic growth.