Stent Implantations Are an Option for Small Patients

Saved image of implanted stent without contrast in vessel

Successful stent implantation for coarctation of the aorta in young patient

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Studies have demonstrated stent implantation is more effective and safer than balloon angioplasty for the treatment of coarctation of the aorta in adult and older pediatric patients. In patients weighing 20 kg or less, balloon angioplasty is performed more often due to challenges in smaller patients, such as smaller vessel sizes, limitations of technology and materials, and patient growth.

The Heart Center at Nationwide Children’s Hospital’s approach to coarctation of the aorta is determined by a multidisciplinary group by case. Since 2004, clinicians at Nationwide Children’s have sometimes opted for implantation of stents that can later dilate to adult size.

In a new study published in Circulation: Cardiovascular Interventions, researchers evaluated outcomes for the treatment of coarctation of the aorta in 39 patients over 12 years who underwent stent implantation at The Heart Center. They found that stent implantation is a safe and effective option for patients, with a 97% success rate.

 

“We were able to double the size of the stenotic lesion and decrease the pressure gradient to a median of 0 mm mercury, essentially eliminating the pressure gradient,” says Brian Boe, MD, a congenital interventional cardiologist at Nationwide Children’s and one of the study’s authors.

The procedure does have risks. Seven patients (18%) experienced adverse events, vascular injury being most common.

“One of the risks of this procedure in small children is injuring the femoral artery,” says Aimee Armstrong, MD, director of Cardiac Catheterization and Interventional Therapies at Nationwide Children’s and another of the study’s authors. “In this study, 14% of patients had a vascular injury long-term.”

Most patients return to the catheterization laboratory about four years after their first procedure to enlarge their stent.

Aimee Armstrong, MD

“One of the risks of this procedure in small children is injuring the femoral artery. In this study, 14% of patients had a vascular injury long-term.”

Aimee Armstrong, MD, director of Cardiac Catheterization and Interventional Therapies

 

Over a five-year follow-up period, about 70% of patients were without significant complications of aortic coarctation, meaning no hypertension and no pressure difference measured by blood pressure cuffs in the clinic.

The team is working to reduce the number of patients who experience vascular injury — through innovative stent development and clinical changes, such as using ultrasound guidance for vascular access.

“Changes including the use of ultrasound guidance to help guide vascular access and instituting protocols for the early identification and treatment of vascular injuries decrease the rate of access-related complications. And as new technologies are developed, this treatment will become even safer for more and smaller patients,” says Dr. Boe.

REFERENCE:
Boe BA, Armstrong AK, Janse SA, Loccoh EC, Stockmaster K, Holzer RJ, Cheatham SL, Cheatham JP, and Berman DP. Percutaneous implantation of adult sized stents for coarctation of the aorta in children </=20 kg: A 12-year experience. Circulation: Cardiovascular Interventions. 2021;14:e009399.