Transcatheter stent implantation for the treatment of abdominal aortic coarctation and right renal artery stenosis in takayasu's arteritis: a case with a 4-year follow up.

We describe a Takayasu arteritis patient who was admitted because of an abdominal aortic stenosis, further complicated by the presence of a stenotic right renal artery located in the area of the aortic stenosis. After treatment of the renal stenosis with a 4 × 15 mm Driver stent, a 16 × 60 self-expandable nitinol stent (OptiMed) was deployed through the stenosis of the abdominal aorta. Even though the right renal artery was initially compromised after stent deployment through the aortic stenosis, the patient was successfully treated with renal artery re-dilation by a balloon passed through open cells of the aortic stent. During follow up, the patient suffered no procedure-related complications.

Coarctoplasty with self-expandable stent implantation for treatment of coarctation of aorta in adults.

BACKGROUND: Balloon angioplasty for treatment of coarctation of the aorta in adults, though promising, is sometimes limited by significant residual gradient (> 20 mmHg). Few studies have been reported on use of balloon-expandable stents in such a situation. We evaluated the use of self-expandable stents in patients with coarctation of the aorta. METHODS: Eight hypertensive patients (age 15 to 27 years) with coarctation of the aorta (n = 6) or recoarctation (n = 2) and peak systolic gradient of > 40 mmHg underwent stent implantation. Balloon predilatation was done and self-expandable nitinol aortic stents (Optimed) were implanted in all patients. RESULTS: The mean +/- SD peak systolic gradient decreased from a baseline of 55 +/- 15 (range: 40 - 75) to 5 +/- 2 (range: 3 - 7) mm Hg after angioplasty. Nitinol stents were easier to deploy and conformed better to aortic anatomy as compared with balloon-expandable stents. The mean +/- SD diameter of the coarcted segment increased from 3 +/- 1 mm to 16 +/- 2 mm. There were no complications in our series. On 6- to 9-month follow-up, all the implanted stents remained in their original positions and none showed evidence of fracture. Significant improvement in hypertension was seen in 7 out of 8 patients. CONCLUSION: Stent implantation is safe and effective in treating coarctation of the aorta. Self-expandable stents were easy to implant, had good adaptation to the wall of the aorta, and in most patients had similar efficacy in reducing coarctation of the aorta as surgical repair.