What studies investigated the efficacy of balloon angioplasty for the treatment of coarctation of the aorta (CoA)?

Updated: Nov 20, 2018
  • Author: Syamasundar Rao Patnana, MD; Chief Editor: Stuart Berger, MD  more...
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Answer

Cowley et al (2005) compared long-term (mean, 10-11 y) results of balloon angioplasty with those of surgery for patients with native aortic coarctation who were randomized at entry into the study and found similar resting blood pressures, residual gradients across the coarctation, exercise performance, aortic arch anatomy based on MRI angiography, and reintervention rates. [79] However, the incidence of aneurysms and greater arm-to-leg blood pressure difference during exercise was higher in the balloon group than in the surgery group.

Cowley et al suggested that surgery is preferable to balloon angioplasty in the management of aortic coarctation in children. Although randomization is a virtue of the study, the study involves only 36 children, with only 21 (58%) returning for reevaluation. Furthermore, other studies in which a larger number of balloon angioplasty procedures were evaluated at long-term follow-up revealed 5% aneurysm formation. Aneurysm formation was also detected in surgical patients. Consequently, a multi-institutional randomized study with a larger number of subjects is in order to resolve the issues brought out by this paper. [73]

Rodés-Cabau et al (2007) compared transcatheter and surgical treatment and concluded that immediate results were similar, but with reduced morbidity and duration of hospitalization with transcatheter intervention. [80] However, angioplasty was associated with a higher rate of reintervention and aneurysm formation.

Wong and associates (2008) used decision analysis to compare preferences for balloon angioplasty versus surgery and concluded that balloon angioplasty is preferred over surgery as the initial treatment for native aortic coarctation in children; however, this type of decision analysis approach was questioned. [81]

Based on the above review, the effectiveness of balloon angioplasty appears to be comparable with that of surgery; the mortality rates are similar (and are probably related to the associated cardiac defects, not related to type of intervention performed), and morbidity and complication rates are lower with balloon angioplasty than with surgical therapy. Balloon angioplasty may be an effective alternative to surgery for the relief of aortic coarctation.


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