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Sagar P, Puthiyedath T, Sivakumar K. First-in-man use of an Indian-made balloon-expandable covered Zephyr stent and intermediate-term follow-up. Ann Pediatr Cardiol 2023; 16:48-51. [PMID: 37287848 PMCID: PMC10243650 DOI: 10.4103/apc.apc_122_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/15/2022] [Accepted: 01/10/2023] [Indexed: 06/09/2023] Open
Abstract
Covered stent is used in large-vessel angioplasty in anticipation of vessel wall injury. Apart from aortic coarctation, they are also used in dysfunctional right ventricular outflow conduits and find a recent role in transcatheter sinus venosus defect closure. Different methods of covering stents include glue fixation, sutureless lamination, sandwich, and sintering lamination. Covered Zephyr (Sahajanand laser technology limited, Gandhinagar, India) is a new Indian-made expanded polytetrafluoroethylene-covered balloon expandable cobalt-chromium stent. Its unique C and S links prevent foreshortening. We report the first-in-man use of this new stent in severe discrete postsubclavian coarctation of aorta and its short-term follow-up imaging.
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Affiliation(s)
- Pramod Sagar
- Department of Pediatric Cardiology, Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai, Tamil Nadu, India
| | - Thejaswi Puthiyedath
- Department of Pediatric Cardiology, Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai, Tamil Nadu, India
| | - Kothandam Sivakumar
- Department of Pediatric Cardiology, Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai, Tamil Nadu, India
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Endovascular treatment of aortic coarctation with a novel BeGraft aortic stent in children and young adults: a single-centre experience with short-term follow-up results. Cardiol Young 2022; 32:451-458. [PMID: 34154687 DOI: 10.1017/s1047951121002389] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES We present our experience and outcomes with the BeGraft in the treatment of aortic coarctation in a predominantly paediatric population. METHODS This study includes a retrospective analysis of patients who had Begraft aortic stent implantation between 2018 and 2020 from a single centre. RESULTS The BeGraft aortic stent was used in 11 patients (7 males, 4 females) with a median age of 14 (13-21) years and a median weight of 65 (46-103) kg. Coarctation was native in five patients and recurrent in six patients. Median stent diameter and length were 16 mm and 38 mm, respectively. The median peak-to-peak pressure was 30 (12-55) mmHg before the procedure and 5 (0-17) mmHg after the procedure. The stenting procedure was successful in 10 of the 11 patients. Stent migration to the abdominal aorta occurred on post-procedure day 1 in the 21-year-old patient, who had previously undergone surgical closure of the ventricular septal defect and balloon angioplasty for coarctation. After repositioning failed, the stent was safely fixed in the abdominal aorta. Strut distortion also occurred during balloon retrieval in one patient, but no aneurysm or in-stent restenosis was observed at 1-year follow-up. The patients were followed for a median of 14 (4-25) months and none required redilation. CONCLUSIONS Our initial results demonstrated that the BeGraft aortic stent effectively reduced the pressure gradient in selected native and recurrent cases. Despite advantages such as a smaller sheath and low profile, more experience and medium- to long-term results are needed.
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Sagar P, Sivakumar K. A covered stent used in aortic coarctation migrates proximally during deployment causing transverse arch obstruction: Transcatheter repositioning after one month. J Cardiol Cases 2020; 24:23-26. [PMID: 34257756 DOI: 10.1016/j.jccase.2020.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 10/22/2020] [Accepted: 11/23/2020] [Indexed: 11/27/2022] Open
Abstract
Stent angioplasty with covered stents to avoid risk of aortic injury is the preferred mode of management of coarctation of aorta in adults and older children. Severe isthmic coarctation in an adult male with uncontrolled systemic hypertension was managed at another institution using a covered stent. A proximal stent migration during deployment resulted in obstruction of transverse aortic arch and left subclavian artery and was recognized one month after the procedure. This resulted in significant aortic gradients and left arm hypoperfusion. It was managed successfully by use of snares and additional overlapping stents, the first of this type in literature. Awareness of factors leading to stent migration and techniques involved in repositioning these stents may help cardiologists who deal with these interventions. <Learning objective: Distal stent migration is a known complication of coarctation stenting, often managed by expanding the stent in descending thoracic aorta where there are no major branches. However, proximal migration of covered stent leads to aortic arch obstruction including occlusion of arch branches. Techniques of delayed percutaneous repositioning of covered stent are described in this report.>.
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Affiliation(s)
- Pramod Sagar
- Department of Pediatric Cardiology, Institute of Cardio Vascular Diseases, Madras Medical Mission, 4A, Dr J J Nagar, Mogappair, Chennai 600037, India
| | - Kothandam Sivakumar
- Department of Pediatric Cardiology, Institute of Cardio Vascular Diseases, Madras Medical Mission, 4A, Dr J J Nagar, Mogappair, Chennai 600037, India
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Jata B, Jahollari A, Kojqiqi A, Huti G. Coarctation of Aorta and Post-Stenotic Dissecting Aortic Aneurysm Successfully Treated with Endovascular Stent. Int Med Case Rep J 2020; 13:367-370. [PMID: 32904705 PMCID: PMC7457696 DOI: 10.2147/imcrj.s267692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 08/08/2020] [Indexed: 11/23/2022] Open
Abstract
Coarctation associated with a dissected aneurysm is uncommon and has an incidence of less than 1%. There are few reports describing treatment of this condition with stent graft. Challenging as it may be, endovascular treatment of complex cases has become the preferred modality especially when the anatomy is amenable. We describe the case of a 36-year old male, who suffered a car accident and was diagnosed with acute type B aortic dissection (ATBAD). CT-scan revealed a coarctation associated with a large dissected aneurysm (11cm). Complexity of pathology and high risk of rupture required immediate intervention. Open repair necessitates extensive surgery with a considerable risk of morbidity and mortality. We decided to perform an endovascular repair and subsequentially the patient was successfully treated with stent graft deployment, showing durable early-midterm results. Patient remains asymptomatic to this day and CT-scan at 3-year follow-up revealed a reduced and thrombosed aneurysm.
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Affiliation(s)
- Bekim Jata
- Department of Invasive Cardiology, American Hospital 3, Tirana, Albania
| | - Artan Jahollari
- Department of Cardio-Vascular Surgery, American Hospital 3, Tirana, Albania
| | - Arben Kojqiqi
- Department of Cardio-Thoracic Surgery, American Hospital 3, Tirana, Albania
| | - Gentian Huti
- Department of Anesthesia and Reanimation, American Hospital 3, Tirana, Albania
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van der Burg JJ, Warmerdam EG, Krings GJ, Meijboom FJ, van Dijk AP, Post MC, Veen G, Voskuil M, Sieswerda GT. Effect of stent implantation on blood pressure control in adults with coarctation of the aorta. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 19:944-950. [PMID: 29752138 DOI: 10.1016/j.carrev.2018.03.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 03/21/2018] [Accepted: 03/22/2018] [Indexed: 01/16/2023]
Abstract
BACKGROUND Stenting of coarctation of the aorta (CoA) generally results in good angiographic results and a decrease in transcoarctation pressure gradient. However, effect on blood pressure control is less clear. The goal of the current retrospective analysis was to investigate the effects of CoA stenting on blood pressure control. METHODS A retrospective analysis was conducted in consecutive adult patients with a CoA who underwent a percutaneous intervention at one of the three participating hospitals. Measurements included office blood pressure, invasive peak-to-peak systolic pressure over the CoA, diameter of the intima lumen at the narrowest part of the CoA and use of medication. The follow-up data were obtained, based on the most recent examination date. RESULTS There were 26 native CoA and 17 recurrent CoAs (total n = 43). Seven of them underwent two procedures. Mean peak-to-peak gradient decreased from 27 mmHg to 3 mmHg (p < 0.001), and minimal diameter increased from a mean of 11 mm to 18 mm (p < 0.001). Mean systolic blood pressure decreased from 151 ± 18 mmHg to 135 ± 19 mmHg at first follow-up of 3.8 ± 1.9 months and 137 ± 22 mmHg at latest follow-up of 19.5 ± 10.9 months (p = 0.001 and p = 0.009, compared to baseline, respectively). The total number of hypertensive patients decreased from 74% to 27% at latest follow-up. No significant change in antihypertensive medication was observed. CONCLUSION A clinically significant decrease in systolic blood pressure of approximately 16 mmHg was shown after (re)intervention in CoA patients, which sustained at follow-up. This sustained decrease of blood pressure can be expected to lead to less future adverse cardiovascular events.
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Affiliation(s)
- Jennifer J van der Burg
- University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands; VU University Medical Center, De Boelelaan 1117, 1081, HV, Amsterdam, The Netherlands
| | - Evangeline G Warmerdam
- University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands
| | - Gregor J Krings
- University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands
| | - Folkert J Meijboom
- University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands
| | - Arie P van Dijk
- Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, The Netherlands
| | - Marco C Post
- University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands; St Antonius Hospital, Koekoekslaan 1, 3435, CM, Nieuwegein, The Netherlands
| | - Gerrit Veen
- VU University Medical Center, De Boelelaan 1117, 1081, HV, Amsterdam, The Netherlands
| | - Michiel Voskuil
- University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands
| | - Gertjan Tj Sieswerda
- University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands.
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