Innovative resource utilization to fashion individualized covered stents in the setting of aortic coarctation.

OBJECTIVES

We describe our experience with self-fabricated covered stents in the setting of coarctation of the aorta (CoA).

BACKGROUND

Balloon-expandable covered stents are increasingly being utilized to treat CoA in older children and adults. These stents however, are not available in the United States limiting the interventionalist's ability to treat this condition safely and effectively.

METHODS

Retrospective analysis and follow-up data review of our complete experience with self-fabricated covered stents for CoA. Stents were fashioned by suturing an appropriate length of tubular polytetraflouroethylene to a bare metal stent and deploying this stent across the coarctation in a standardized fashion.

RESULTS

Over a 9-year period we implanted 53 balloon-expandable stents in 49 patients with CoA. Of these 13 were self-fabricated covered stents deployed in 13 patients (7 male). Median age at implantation was 25.4 years (range, 8.7-49.5 years) with median weight of 65.5 kg (range, 28-168 kg). Indications for stent placement were native coarctation/aortic atresia (n = 9), aneurysm formation (n = 3), and re-coarctation (n = 1). The median systolic pressure gradient across the coarctation of 33 mm Hg (range, 12-69 mm Hg) was reduced to 3 mm Hg (range, 0-19 mm Hg) post procedure (P < 0.001). There were no deaths on median follow-up of 44 months (range, 1-83 months). One patient developed acute contained extravasation at implantation, treated with a self-expanding stent graft. Another patient required thrombectomy for femoral arterial thrombosis.

CONCLUSIONS

Innovative application of available materials adds to the armamentarium of the interventionalist. Our self-fabricated covered stent provides effective gradient reduction with no compromise in stent delivery or durability on follow-up.