Stenting of coarctation of aorta

Stenting of coarctation of aorta

Stenting of native coarctation of aorta has to be taken up with extreme care as there is a possibility of dissection and rupture. Stenting of re-coarctation after an initial surgical repair is safer due to the presence of fibrosis around the aortic wall. Stenting of native coarctation is usually done at around 3 to 4 atmospheres of pressure in the dilating balloon. It is not necessary to fully dilate the coarctation in a single setting as it increases the chance of complications. A small step can be left and taken up as a re procedure after 3 to 6 months when fibrosis around the site would make the procedure safer. If the step is not removed by redilatation at a later date, there is a chance of strut fracture of the stent at the site. This in turn will lead to more fibrosis and restenosis of the coarct segment. Hence it is a good practice to call back and redilate after 3 to 6 months to smooth out the lumen of the stent. While taking the measurement of the required stent, the decrease in length of the stent during expansion has to be taken into account. The expanded length of a 29 x 10 mm stent will be only 27 mm. Larger stents will lose more length on expansion. A catheter introduced through the left radial into the left subclavian is useful in avoiding jailing of the left subclavian orifice during coarctation stenting.

In case there is a leakage from the aorta after balloon dilatation, the balloon should be reinflated to produce local tamponade and the person shifted for surgical repair. Keeping the aorta occluded by balloon inflation may not produce much distal ischemia as there will be adequate collaterals in coarctation. An alternative option in case of leakage is to close it off by a covered stent.