Covered Stents for Treating/Preventing Aortic Wall Injury
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)?
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.
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.
The authors concluded that CCPS can effectively treat and potentially prevent aortic wall injury associated with CoA.
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.
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