Covered Stents for Treating/Preventing Aortic Wall Injury

Study Questions:

What is the safety and short-term efficacy of the Covered Cheatham-Platinum stent (CCPS) in treating or preventing aortic wall injury (AWI) in patients with coarctation of the aorta (CoA)?

Methods:

The COAST II (Covered Cheatham-Platinum Stents for Prevention or Treatment of Aortic Wall Injury Associated With Coarctation of the Aorta Trial) is a multicenter, single-arm trial using the CCPS for the treatment and/or prevention of AWI in patients with CoA and pre-existing AWI or increased risk of AWI. Patients were enrolled if they had a history of CoA with pre-existing AWI (Treatment group) or with increased risk of AWI (Prevention group). Pre/post-implant hemodynamics and angiography were reported. A core lab performed a standardized review of all angiograms. One-month follow-up was reported.

Results:

A total of 158 patients (65% male; median age, 19 years) underwent placement of CCPS. Eighty-three patients had pre-existing AWI. The average ascending-to-descending aorta systolic gradient improved from 27 ± 20 mm Hg to 4 ± 6 mm Hg. Complete coverage of pre-existing AWI was achieved in 66/71 patients (93%) with AWI who received a single CCPS. Ultimately, complete coverage of AWI was achieved in 76/83 patients (92%); seven patients had minor endoleaks that did not require repeat intervention. Four patients experienced important access site vascular injury. There were no acute AWIs, repeat interventions, or deaths.

Conclusions:

The authors concluded that CCPS can effectively treat and potentially prevent aortic wall injury associated with CoA.

Perspective:

This study reports that CCPS can be used to effectively treat existing AWI and may prevent AWI in patients undergoing stent therapy for CoA. Placement of the CCPS has a high rate of technical success and short-term hemodynamic improvement. These acute results appear to support the use of covered stents as a safe and effective treatment option for CoA and AWI. Mid- to long-term follow-up of these patients are indicated to confirm durability and safety of this modality.

Clinical Topics: Congenital Heart Disease and Pediatric Cardiology, Invasive Cardiovascular Angiography and Intervention, Prevention, Vascular Medicine, Congenital Heart Disease, CHD & Pediatrics and Arrhythmias, CHD & Pediatrics and Imaging, CHD & Pediatrics and Interventions, Interventions and Imaging, Interventions and Structural Heart Disease, Interventions and Vascular Medicine, Angiography, Nuclear Imaging

Keywords: Angiography, Aortic Coarctation, Endoleak, Heart Defects, Congenital, Hemodynamics, Stents, Secondary Prevention, Vascular Diseases, Vascular System Injuries


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