Ahsan Beg.
Feasibility of use of covered stents in coarctation of the aorta and its immediate outcome.
J Cardiovascular Dis Jan ;16(3):112-6.

BACKGROUND:Endovascular stenting in coarctation of the aorta is preferable in adolescents and adults, as it is carries less risk of restenosis and aneurysm formation. There is limited study data for early results of using covered stents, as primary treatment in a developing country. In our setup repeat intervention and follow up are main challenges. OBJECTIVE: To see the feasibility of use of covered stents in coarctation of aorta and its immediate outcome. MATERIAL AND METHODS: This was a case series of patients with coractation of aorta. A total of 22 patients were included regardless of gender with age about 18 years. Twenty two patients were implanted 23 covered stents (Cheatham-Platinum stents) at a single center, CPE Institute of Cardiology, Multan, Pakistan. One patient had emergency rescue treatment. Mean age was 20 +-8 (range 11 to 39) years and mean weight 48.6 +-7 (39 - 60) kg. Variables measured were regression of peak to peak systolic gradient and an increase in diameter of coarctation site narrow point. RESULTS: 22 patients underwent implantation of Covered Cheatham Platinum (CP) stents from February 2010 to June 2019. There was significant reduction of mean systolic gradient from 42+-2 mmHg to 8+-6 mm Hg (P< 0.0001). There was significant increase of mean diameter of coarctation narrow point from 3.9mm (+-0.2) to14.9 mm (+-1.7 mm).There was no death. No patient developed dissection or aneurysm formation when evaluated 24 hrs after the procedure. No patient had a stent migration or stent fracture. No case was abandoned or referred for surgery. Three patients had blood transfusion during the procedure due to bleeding while procedure. External iliac artery injury requiring immediate stenting was needed in one patient. Two patients had loss of lower limb pulses which was resolved successfully with anticoagulation by using heparin infusion. One patient had thrombus formation at right brachial artery requiring embolectomy by forgarty catheter with no residual loss. CONCLUSION: Covered Cheatham Platinum stents are safe and effective in the management of coarctation of the aorta in adolescents and adults. It is a feasible option in a resource-limited country where re-intervention and follow up are major issues.

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