TY - JOUR
T1 - Percutaneous Balloon-Expandable Stent Implantation to Treat Transverse Aortic Arch Obstruction
T2 - Medium- to Long-Term Outcomes of a Retrospective Multicenter Study
AU - Salavitabar, Arash
AU - Eisner, Mariah
AU - Armstrong, Aimee K
AU - Boe, Brian A
AU - Chisolm, Joanne L
AU - Cheatham, John P
AU - Cheatham, Sharon L
AU - Forbes, Thomas
AU - Jones, Thomas K
AU - Krings, Gregor J
AU - Morray, Brian H
AU - Steinberg, Zachary L
AU - Akam-Venkata, Jyothsna
AU - Voskuil, Michiel
AU - Berman, Darren P
N1 - Publisher Copyright:
© 2024 American Heart Association, Inc.
PY - 2024/7
Y1 - 2024/7
N2 - BACKGROUND: Transverse aortic arch obstruction is a challenging lesion for which stent implantation provides a potentially important alternate therapy. The objectives were to evaluate the technical, procedural, and medium-to-long-term clinical outcomes of percutaneous stent implantation of transverse aortic arch obstruction.METHODS: This is a retrospective, multicenter study of transverse aortic arch stent implantation. Univariable and multivariable analyses were performed.RESULTS: Index catheterization included 187 stent implants in 146 patients. The median age is 14.3 years (interquartile range, 9.3-19), weight is 53 kg (30-69), and follow-up is 53 months (12-120). The most common stent design was open cell (n=90, 48%). Stents overlapped 142 arch vessels (37 carotid arteries) in 118 (81%) cases. Technical and procedural success rates were 100% and 88%, respectively. Lower weight (
P=0.018), body surface area (
P=0.013), and minimum-to-descending aortic diameter ratio (
P<0.001) were associated with higher baseline aortic gradient. The residual gradient was inversely associated with implant and final dilation diameters (
P<0.001). The combined incidence of aortic injury and stent-related complications was 14%. There were no reports of abnormal brain scans or stroke. Blood pressure cuff gradient, echocardiographic arch velocity, and hypertension rates improved within 1-year follow-up with increased antihypertensive medication use. Reintervention was reported in 60 (41%) patients at a median of 84 (22-148) months to first reintervention. On multivariable logistic regression, residual aortic gradient >10 mm Hg was associated with increased odds of reintervention at all time points when controlling for each final dilation diameter, weight, and minimum-to-descending aortic diameter ratio.
CONCLUSIONS: Transverse aortic arch stent implantation has high rates of technical, procedural, and medium-to-long-term clinical success. Aortic gradient >10 mm Hg is associated with increased odds of reintervention at 1-year and most recent follow-ups. Open cell stent design was frequently used for its advantages in conformability, perfusion of arch vessels, low fracture rate, and the ability to perform effective angioplasty of side cells.
AB - BACKGROUND: Transverse aortic arch obstruction is a challenging lesion for which stent implantation provides a potentially important alternate therapy. The objectives were to evaluate the technical, procedural, and medium-to-long-term clinical outcomes of percutaneous stent implantation of transverse aortic arch obstruction.METHODS: This is a retrospective, multicenter study of transverse aortic arch stent implantation. Univariable and multivariable analyses were performed.RESULTS: Index catheterization included 187 stent implants in 146 patients. The median age is 14.3 years (interquartile range, 9.3-19), weight is 53 kg (30-69), and follow-up is 53 months (12-120). The most common stent design was open cell (n=90, 48%). Stents overlapped 142 arch vessels (37 carotid arteries) in 118 (81%) cases. Technical and procedural success rates were 100% and 88%, respectively. Lower weight (
P=0.018), body surface area (
P=0.013), and minimum-to-descending aortic diameter ratio (
P<0.001) were associated with higher baseline aortic gradient. The residual gradient was inversely associated with implant and final dilation diameters (
P<0.001). The combined incidence of aortic injury and stent-related complications was 14%. There were no reports of abnormal brain scans or stroke. Blood pressure cuff gradient, echocardiographic arch velocity, and hypertension rates improved within 1-year follow-up with increased antihypertensive medication use. Reintervention was reported in 60 (41%) patients at a median of 84 (22-148) months to first reintervention. On multivariable logistic regression, residual aortic gradient >10 mm Hg was associated with increased odds of reintervention at all time points when controlling for each final dilation diameter, weight, and minimum-to-descending aortic diameter ratio.
CONCLUSIONS: Transverse aortic arch stent implantation has high rates of technical, procedural, and medium-to-long-term clinical success. Aortic gradient >10 mm Hg is associated with increased odds of reintervention at 1-year and most recent follow-ups. Open cell stent design was frequently used for its advantages in conformability, perfusion of arch vessels, low fracture rate, and the ability to perform effective angioplasty of side cells.
KW - aorta
KW - balloon angioplasty
KW - cardiac catheterization
KW - congenital heart disease
KW - hypertension
KW - stents
UR - http://www.scopus.com/inward/record.url?scp=85198360748&partnerID=8YFLogxK
U2 - 10.1161/CIRCINTERVENTIONS.123.013729
DO - 10.1161/CIRCINTERVENTIONS.123.013729
M3 - Article
C2 - 38666384
SN - 1941-7640
VL - 17
SP - 587
EP - 595
JO - Circulation. Cardiovascular Interventions
JF - Circulation. Cardiovascular Interventions
IS - 7
M1 - e013729
ER -