Overlapping Covered Stents to Exclude a Postcoarctation Stenting Aortic Aneurysm
Abraham Rothman, MD, Gary A Mayman, MD, William N Evans, MD, Dean Berthoty, MD
ChildrenŐs Heart Center Nevada, 3006 S Maryland Parkway, Ste 690, Las Vegas, Nevada 89109, USA. E-mail: email@example.com
An 18-year-old boy who underwent coil occlusion of a patent ductus arteriosus and stenting for aortic coarctation at 13 years of age had evidence of restenosis. Cardiac catheterization and angiography showed a 25-mm Hg gradient across the stent and a large aneurysm originating at midstent level. The aneurysm measured 2 cm in width and 4.3 cm in length. At a subsequent catheterization procedure, two 4.5-cm-long overlapping Cheatham platinum covered stents were implanted, completely excluding the aneurysm. Computed tomographic (CT) angiography 2 years later showed no evidence of endoleak or re-stenosis.
Balloon dilation and stenting are now widely used to treat aortic coarctation. Complications of these procedures include re-stenosis and aneurysm formation. The incidence of post procedure aneurysm formation varies between 3% and 11.5% after balloon dilation and between 1% and 17% after stenting. Small aneurysms generally have been managed conservatively, whereas larger ones have been treated by surgery or interventional catheterization. Recent reports describe the use of covered stents to exclude post coarctation aneurysms in a limited number of patients. Most series report the use of a single stent to exclude the aneurysm. In this report we describe the use of two overlapping covered stents to exclude a relatively long aneurysm secondary to previous coarctation stenting.