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Salavitabar A, Eisner M, Armstrong AK, Boe BA, Chisolm JL, Cheatham JP, Cheatham SL, Forbes T, Jones TK, Krings GJ, Morray BH, Steinberg ZL, Akam-Venkata J, Voskuil M, Berman DP. Percutaneous Balloon-Expandable Stent Implantation to Treat Transverse Aortic Arch Obstruction: Medium- to Long-Term Outcomes of a Retrospective Multicenter Study. Circ Cardiovasc Interv 2024; 17:e013729. [PMID: 38666384 DOI: 10.1161/circinterventions.123.013729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 03/15/2024] [Indexed: 07/18/2024]
Abstract
BACKGROUND Transverse aortic arch obstruction is a challenging lesion for which stent implantation provides a potentially important alternate therapy. The objectives were to evaluate the technical, procedural, and medium-to-long-term clinical outcomes of percutaneous stent implantation of transverse aortic arch obstruction. METHODS This is a retrospective, multicenter study of transverse aortic arch stent implantation. Univariable and multivariable analyses were performed. RESULTS Index catheterization included 187 stent implants in 146 patients. The median age is 14.3 years (interquartile range, 9.3-19), weight is 53 kg (30-69), and follow-up is 53 months (12-120). The most common stent design was open cell (n=90, 48%). Stents overlapped 142 arch vessels (37 carotid arteries) in 118 (81%) cases. Technical and procedural success rates were 100% and 88%, respectively. Lower weight (P=0.018), body surface area (P=0.013), and minimum-to-descending aortic diameter ratio (P<0.001) were associated with higher baseline aortic gradient. The residual gradient was inversely associated with implant and final dilation diameters (P<0.001). The combined incidence of aortic injury and stent-related complications was 14%. There were no reports of abnormal brain scans or stroke. Blood pressure cuff gradient, echocardiographic arch velocity, and hypertension rates improved within 1-year follow-up with increased antihypertensive medication use. Reintervention was reported in 60 (41%) patients at a median of 84 (22-148) months to first reintervention. On multivariable logistic regression, residual aortic gradient >10 mm Hg was associated with increased odds of reintervention at all time points when controlling for each final dilation diameter, weight, and minimum-to-descending aortic diameter ratio. CONCLUSIONS Transverse aortic arch stent implantation has high rates of technical, procedural, and medium-to-long-term clinical success. Aortic gradient >10 mm Hg is associated with increased odds of reintervention at 1-year and most recent follow-ups. Open cell stent design was frequently used for its advantages in conformability, perfusion of arch vessels, low fracture rate, and the ability to perform effective angioplasty of side cells.
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Affiliation(s)
- Arash Salavitabar
- The Heart Center, Nationwide Children's Hospital, Columbus, OH (A.S., A.K.A., J.L.C., J.P.C., S.L.C.)
| | - Mariah Eisner
- Biostatistics Resource at Nationwide Children's Hospital, Columbus, OH (M.E.)
| | - Aimee K Armstrong
- The Heart Center, Nationwide Children's Hospital, Columbus, OH (A.S., A.K.A., J.L.C., J.P.C., S.L.C.)
| | - Brian A Boe
- The Heart Institute, Joe DiMaggio Children's Hospital, Hollywood, FL (B.A.B., T.F., J.A.-V.)
| | - Joanne L Chisolm
- The Heart Center, Nationwide Children's Hospital, Columbus, OH (A.S., A.K.A., J.L.C., J.P.C., S.L.C.)
| | - John P Cheatham
- The Heart Center, Nationwide Children's Hospital, Columbus, OH (A.S., A.K.A., J.L.C., J.P.C., S.L.C.)
| | - Sharon L Cheatham
- The Heart Center, Nationwide Children's Hospital, Columbus, OH (A.S., A.K.A., J.L.C., J.P.C., S.L.C.)
| | - Thomas Forbes
- The Heart Institute, Joe DiMaggio Children's Hospital, Hollywood, FL (B.A.B., T.F., J.A.-V.)
| | - Thomas K Jones
- Seattle Children's Hospital, WA (T.K.J., B.H.M., Z.L.S.)
| | - Gregor J Krings
- Department of Pediatric Cardiology, Wilhelmina Children's Hospital of the University Medical Center Utrecht, the Netherlands (G.J.K.)
| | - Brian H Morray
- Seattle Children's Hospital, WA (T.K.J., B.H.M., Z.L.S.)
| | - Zachary L Steinberg
- Seattle Children's Hospital, WA (T.K.J., B.H.M., Z.L.S.)
- Department of Medicine, Division of Cardiology, University of Washington, Seattle (Z.L.S.)
| | - Jyothsna Akam-Venkata
- The Heart Institute, Joe DiMaggio Children's Hospital, Hollywood, FL (B.A.B., T.F., J.A.-V.)
| | - Michiel Voskuil
- Department of Cardiology, University Medical Center Utrecht, the Netherlands (M.V.)
| | - Darren P Berman
- Heart Institute, Children's Hospital Los Angeles, CA (D.P.B.)
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Haddad RN, Bonnet D, Malekzadeh-Milani S. Failure to post-dilate BeSmooth peripheral stents to adult vessel size diameters during benchside tests. Cardiol Young 2023; 33:2597-2603. [PMID: 37073828 DOI: 10.1017/s1047951123000720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
BACKGROUND Low-profile stent implantation remains a rescue treatment for aortic coarctation and branch pulmonary arteries stenosis in small children. Stent re-expansion to cope with vascular growth remains problematic. OBJECTIVES To evaluate ex vivo feasibility and mechanical behaviour of over-dilating BeSmooth peripheral stents (Bentley InnoMed, Germany). METHODS Three BeSmooth peripheral stents in diameters of 7, 8, and 10 mm were dilated to nominal pressure and then 13 atm. BeSmooth Ø7 × 23 mm was sequentially post-dilated using 12, 14, and 16 mm high-pressure balloons. BeSmooth Ø10 × 57 mm was post-dilated with a 14 mm balloon and then with a 48 mm bare-metal Optimus XXL stent hand-mounted on a 14 mm balloon (stent-in-stent). BeSmooth Ø8 × 57 mm was directly post-dilated with a 48 mm bare-metal Optimus XXL stent hand-mounted on a 16 mm balloon (stent-in-stent). The stents' diameter and length were measured. Digital inflation pressure was noted. Balloon rupture and stent fracture patterns were closely evaluated. RESULTS At 20atm pressure, BeSmooth Ø7 × 23 mm shortened to 2 mm forming a 12 mm diameter solid ring circle and the woven balloon ruptured radially. At 10 atm pressure, BeSmooth Ø10 × 57 mm fractured longitudinally in various dispatched breaking points at a diameter of 13 mm without shortening and ruptured the balloon with multiple pinholes. At 10 atm pressure, BeSmooth Ø8 × 57 mm fractured centrally at three different points at a diameter of 11.5 mm without shortening and the balloon broke radially in half. CONCLUSIONS In our benchmark tests, extreme shortening, severe balloon rupture, or unpredictable stent fracture patterns at small balloon diameters limits safe post-dilation of BeSmooth stents beyond 13 mm. BeSmooth stents are not ideal candidates for off-label stent interventions in smaller patients.
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Affiliation(s)
- Raymond N Haddad
- M3C-Necker, Hôpital Universitaire Necker-Enfants malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Damien Bonnet
- M3C-Necker, Hôpital Universitaire Necker-Enfants malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- Université de Paris Cité, Paris, France
| | - Sophie Malekzadeh-Milani
- M3C-Necker, Hôpital Universitaire Necker-Enfants malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
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Abstract
Introduction Coarctation of the aorta in children under 3 months of age is usually treated surgically. However, there are clinical scenarios in which stenting of native or recurrent coarctation may become necessary in this age group. Case reports Four cases illustrate possible indications: left ventricular dysfunction increasing the operative risk, thrombus formation after coarctation surgery, patient size (i.e. in premature babies), and retrograde arch obstruction after hybrid palliation of hypoplastic left heart syndrome. In all babies, coarctation stenting was carried out successfully without complications. Conclusion Coarctation stenting can be carried out safely in small children. Usually, the stent has to be removed or redilated later. Results are encouraging. Electronic supplementary material The online version of this article (10.1007/s12471-020-01371-8) contains supplementary material, which is available to authorized users.
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Matteo J, Hood P, Hulsberg PC, Eadie E, Soule E, Shabandi M, Harmon TS. Larger Sizes Matter More! Applying the Matteo Mathematics Method for Endovascular Aortic Bifurcation Reconstruction to Large Venous Vascular Repair. Cureus 2018; 10:e3537. [PMID: 30648070 PMCID: PMC6318114 DOI: 10.7759/cureus.3537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 11/02/2018] [Indexed: 11/05/2022] Open
Abstract
Endovascular aortobifemoral bypass repair with aortic bifurcation reconstruction is a well-established option with mortality benefits compared to conventional surgical management. The same theory, formulas, and techniques can be applied to the central venous system as long as there are commercially available devices. Using mathematically derived criteria for optimal stent size selection, endovascular aortic bifurcation reconstruction with kissing stents was extrapolated to the inferior vena cava (IVC). This report describes a traumatic case of IVC injury that was successfully repaired using the standard aortic grafts while adhering to the guidelines for proper stent size selection.
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Affiliation(s)
- Jerry Matteo
- Interventional Radiology, University of Florida College of Medicine, Jacksonville, USA
| | - Preston Hood
- Interventional Radiology, University of Florida College of Medicine, Jacksonville, USA
| | - Paul C Hulsberg
- Interventional Radiology, University of Florida College of Medicine, Jacksonville, USA
| | - Erik Eadie
- Interventional Radiology, University of Florida College of Medicine, Jacksonville, USA
| | - Erik Soule
- Interventional Radiology, University of Florida College of Medicine, Jacksonville, USA
| | - Michael Shabandi
- Interventional Radiology, University of Florida College of Medicine, Jacksonville, USA
| | - Taylor S Harmon
- Interventional Radiology, The University of Texas Medical Branch, Galveston, USA
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Krasemann T, Kruit MN, van der Mark AE, Zeggelaar M, Dalinghaus M, van Beynum IM. Dilating and fracturing side struts of open cell stents frequently used in pediatric cardiac interventions-An in vitro study. J Interv Cardiol 2018; 31:834-840. [PMID: 30091244 PMCID: PMC6585776 DOI: 10.1111/joic.12549] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 07/16/2018] [Accepted: 07/17/2018] [Indexed: 12/01/2022] Open
Abstract
Background Open cell stents are frequently used in interventional therapy of congenital heart disease. Overstenting of vessel branches may necessitate strut dilation. Methods and Results The strut size achievable in Bard Valeo and Cook Formula stents, and the pressure necessary to fracture struts was assessed. In addition, a self expanding stent (Optimed SinusflexDS) was also tested. With the original balloon at nominal pressure, in Valeo stents side struts could be dilated to approximately 90% of the nominal stent diameter, in Formula stents to approximately 80%. With larger high pressure woven balloons, strut size increased to approximately 125% in Valeo stents, and to approximately 105% in the Formula. Strut fracture can connect two adjoining struts. Pressures were dependent on the balloon utilized. Sidestruts of the Sinusflex could lastingly overdilated with large balloons only. Conclusion Dilation and overdilation of side struts in open cell stents can be achieved. Dependent on the clinical context, the original balloon used to place the premounted stent can be used to achieve strut dilation, but woven high pressure balloons maybe safer for patients. Should a larger diameter be required, these high pressure woven balloons can achieve bigger diameters and even strut fracture.
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Affiliation(s)
- Thomas Krasemann
- Division of Cardiology, Department of Pediatrics, Sophia Kinderziekenhuis, Erasmus Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Marco N Kruit
- Division of Cardiology, Department of Pediatrics, Sophia Kinderziekenhuis, Erasmus Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Arthur E van der Mark
- Division of Cardiology, Department of Pediatrics, Sophia Kinderziekenhuis, Erasmus Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Martijn Zeggelaar
- Division of Cardiology, Department of Pediatrics, Sophia Kinderziekenhuis, Erasmus Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Michiel Dalinghaus
- Division of Cardiology, Department of Pediatrics, Sophia Kinderziekenhuis, Erasmus Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Ingrid M van Beynum
- Division of Cardiology, Department of Pediatrics, Sophia Kinderziekenhuis, Erasmus Medical Centre Rotterdam, Rotterdam, The Netherlands
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