Background: Covered stents (CS) have been suggested as an alternative to bare stents to decrease aortic complications in moderate-severe native CoA. Methods: We retrospectively reviewed our 18 patients (26.7±14.6 yo; 12 to 58) who underwent CS implantation since 2003 (Cheatham-Platinium stent, 8 zig, length 22 to 45mm). Results: Preimplantation systolic blood pressure was 147.9±17.5 mmHg, with mean pressure gradient of 63.3 mmHg (41 to 103). 11/16 hypertensive patients were under medication, 8/11 had at least 2 medications. Significant collaterals were present in 15/18 patients. All attempts were successful. Lesion diameter/aortic diameter at diaphragm increased from 20.7%±11.0% to 90.2%±15.8%. Invasive gradient (under general anesthesia) decreased from 33.4±11.1 to 1.4±2.8 mmHg. One major complication occurred (mild cerebrovascular ischemic event in a 46.9 yo). Sub-clavian artery was partially jailed in 4/18, with none losing radial pulse. 4 patients had almost atretic lesion (< 1 mm), one needing radiofrequency perforation for acquired interruption.
During follow up (mean 15.8 mo, 1 to 49.5), 13 patients have already undergone non invasive imaging, with one demonstrating a small (6 mm) aneurysm. No stent fracture was observed. Three of our 8 teenager patients underwent further dilatation to accommodate aortic growth. Normal blood pressure was obtained in 8/16 previously hypertensive patients. Only one patient has blood pressure gradient >20 mmHg, due to aortic arch hypoplasia. Conclusion: CS implantation is safe in moderate-severe native CoA, and provides excellent transcoarctation gradient relief. These results compare favorably to our previously reported experience with balloon dilatation and bare stents implantation in native coarctation.