What are the indications for covered stents in coarctation of the aorta (CoA) repair?

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

Experience in the use of covered stents to manage aortic coarctation is limited. [126, 135, 136, 137, 138, 139, 140, 141] Different types of stents to treat aortic coarctation have been used and include Jostent grafts, C-P stents, and AneuRx. Although these stents are available outside the United States, none are yet approved for clinical use by the US Food and Drug Administration (FDA). However, customizing and off-label use of available endoluminal grafts are feasible, when necessary. [142] The indications for intervention are similar to those used for balloon angioplasty and deployment of the standard stent.

The indications for use of covered stents include postangioplasty aneurysm, tortuous aortic arch and isthmus, associated patent ductus arteriosus, prior surgical conduit, Takayasu arteritis, and extremely narrow (subatretic) coarcted segment. When the assessed risk for development of aneurysm or dissection is high, a covered stent should be used. The results of the limited use of covered stents appear to be good. [126, 135, 136, 137, 138, 139, 140, 141] Some of the stents can be expanded to only an 18-mm diameter. In addition, the stent shortens when expanded to larger diameters. Use of covered stents has another disadvantage in that the vessels that arise from the aorta are blocked.

Aortic rupture remains an important, though an infrequent, complication following primary stenting for aortic coarctation. Covered stents have been used to reduce this risk. However, aortic rupture has been reported even with covered stents. [143]

Renarrowing of covered stents has been reported, and data in limited number of patients suggest Covered Cheatham-Platinum stents can redilated. [144]

A comparison between bare and covered Cheatham-platinum stents in a randomized clinical trial of 120 patients, aged 23.60 ± 10.99 years at a follow-up duration of 31.1 ± 19.2 months revealed a higher prevalence of recoarctation in bare metal stents and greater occurrence of pseudoaneurysm in covered stents; neither of these achieved statistical significance, however. Number of subjects with normal blood pressure increased in both groups. [145] Collapse and infolding of the covered stents can occur with the use of covered stents, requiring placement of additional stents. [146, 96]

Based on the currently available data, the covered stents may be useful in highly selected patients with aortic coarctation.


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