COA management is a life long process beginning with surgical repair. With growth and time,1. recoarctation, 2.hypoplastic arch segments(transverse arch (TAh) between IA and LCA , distal arch(DAh)between LCA and LSCA, isthmus (AIh) between LSCA and Desc.AO(DAO), 3.arch distortion(AD) and 4. Proximal hypertension can develop, necessitating further surgical or interventional management.
Aim: To review efficacy of single operator interventional COA stents(yr2000-2008)to address the above issues
Methods and observation: Of 100 pts followed up from 1-30yrs serially with 2D,Bp,exercise tests and mri/cta,13 pts.(12yr-30yr,wt.43-121kgm64.9)had “recurrence”and 5pts with native COA underwent J&J/CP stenting
ANATOMY OF ARCH
COA type PATIENTS AD TAh DAh AIh

NATIVE 5 0 1* 1* 4 +1*
SUBCLFLAP 7 4 3 6 1
END – END 6 2 2 4* 4*
* same pts

STENT PLACEMENT SITE (DILATED 16-20MM)
COA TYPE TAh DAh + AIh AIh
NATIVE 1* 2 + 1* 2 +1*
SUBCLFLAP 0 6 1
END-END 2 4 0

RESULTS: 1. Gradients >30mmhg reduced to below 5mmhg. 2. Aortic arch diameter increased to 15 – 20mm at stented site.2. Hypertension improved in most cases.3 Better exercise endurance 4. Arch distortion improved 3pts.
COMPLICATIONS:1.Stent malposition in 3 pts,-parked safely 2.aortic intimal tear 1pt-resolved. 3. Prolonged catheter 1pt. 4. RFA haematoma 5pts. 5. “jailed “LSCA 5pts, LCA 1pt. NO MAJOR COMPLICATIONS.

CONCLUSION: 1.segmental aortic arch stenting can be safely undertaken.2.arch anatomy and diameter are improved 3.hypertension and exercise tolerance are improved .4. surgery is minimised.5.long term effects of coa stents however remain unknown.