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Title: Balloon-expandable stent repair of severe coarctation of aorta
Authors: Suárez de Lezo, José María
Pan, Manuel
Romero, Miguel
Medina, Alfonso
Segura, José
Pavlovic, Djordje
Martínez, Carlos
Tejero, Ignacio
Pérez Navero, Juan
Torres, Francisco
Lafuente, Mercedes
Hernández, Enrique
Melián, Francisco
Concha, Manuel
UNESCO Clasification: 320501 Cardiología
Issue Date: 1995
Journal: The American heart journal 
Abstract: Experimental studies have shown that stents implanted at the aorta become incorporated within the aortic wall and can be further expanded in growing animals. This study evaluates the feasibility and immediate results of balloon-expandable stent implantation in 10 patients with severe coarctation of aorta. The ages of the patients ranged from 1 month to 43 years; 1 was an infant, 8 were children (mean age 5.3 +/- 4 years), and 1 was an adult. All had an unfavorable anatomy for balloon angioplasty; 9 had isthmus hypoplasia. Balloon predilation was first performed and its immediate effect evaluated. Then a balloon-expandable stent that was 30 mm long and covered the isthmus and coarctation levels was deployed, and it was further expanded to the preselected final diameter (12 +/- 4 mm). A final hemodynamic and angiographic evaluation was then obtained. Full deployment of an incompletely expanded and distally displaced stent in the infant led to aortic disruption that was controlled by a second stent covering the disrupted zone and the isthmus. After balloon angioplasty alone was done, the mean gradient (43 +/- 12 vs 31 +/- 10 mm Hg) and the percentage stenosis (72% +/- 11% vs 54% +/- 11%) had an insufficient decrease. However, after stent implantation was done, the gradient almost disappeared (mean 2 +/- 3 mm Hg). The angiographic stenosis disappeared in 7 patients and was markedly reduced in 3. The ratio of isthmus/descending aorta changed from 0.65 +/- 0.14 to 1 +/- 0.08 (p < 0.01). Three patients with distorted coarctation had a favorable acute remodeling of the aortic arch after stent implantation. After 4.4 +/- 2.5 months all patients have no symptoms and normal blood pressure. These findings show that balloon-expandable stent repair of severe coarctation of the aorta is feasible and provides optimal immediate relief. However, progressive stent expansion will be needed in small children as demanded by somatic growth.
ISSN: 0002-8703
DOI: 10.1016/0002-8703(95)90123-X
Source: The American heart journal [ISSN 0002-8703], v. 129 (5), p. 1002-1008, (Mayo 1995)
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