What are the future directions of 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

Causes of recoarctation following balloon angioplasty have been extensively investigated, [82, 148, 149] and factors predictive of recoarctation have been identified and include young age and severely narrowed isthmus and coarcted segment. More recently, studies of biophysical characteristics of the coarcted segment revealed less recoil in the subset of recoarctation patients, implying that the elastic properties of the aortic wall are not preserved. [150] This may be related to cystic medial necrosis [151, 152] or to extension of the ductal tissue into the aortic wall. [152, 153, 154]

However, the true cellular pathophysiologic mechanisms responsible for recoarctation have not been identified. Once they are identified, appropriate treatment algorithms to prevent recoarctation could be developed to address the pathophysiology. Until such time, keeping coarcted segments open with stents is an attractive option. Unfortunately, the stents, which are metallic, do not grow with the child and cannot be used routinely in neonates and infants.

Biodegradable stents [155, 156] may offer a solution; these stents keep the coarcted aortic segment open for a 3-month to 6-month period, after which the stents dissolve. By then, the ratio of the normal aortic tissue to abnormal tissue may be in favor of the infant, thus preventing recurrence of significant narrowing. However, this hypothesis should be tested in appropriate animal models and stent delivery systems miniaturized so that they can be used in neonates and young infants. Similarly growth stents [157] may allow re-dilatation at a later date.


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