Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Current Cardiology Reports
Published in: Current Cardiology Reports 1/2022

01-01-2022 | Aortic Coarctation | Congenital Heart Disease (RA Krasuski and G Fleming, Section Editors)

Covered Stents in the Management of Aortic Coarctation and Right Ventricular Outflow Tract Obstruction

Authors: Nibras E. El Sherif, Nathaniel W. Taggart

Published in: Current Cardiology Reports | Issue 1/2022

Login to get access

Abstract

Purpose of Review

To review the use of covered stents in the treatment of coarctation of the aorta (CoA) and right ventricle to pulmonary artery (RV-PA) conduit obstruction.

Recent Findings

The only commercially available covered stent approved for treatment of CoA and dysfunctional RV-PA conduits is the covered Cheatham-Platinum stent (CCPS). Early outcomes have demonstrated its safety and have suggested its efficacy in treating or preventing aortic wall injury (AWI) or conduit disruption. A recent study of CCPS use for CoA reported a progressive risk of stent fracture over time and a risk of AWI despite the purported protection that the CCPS provides. The use of other covered stents has been reported, but large, systematic studies are lacking.

Summary

CCPS use may reduce but does not eliminate the risk of conduit disruption or AWI. Structural limitations of the CCPS may predispose it to stent fracture. Access to a broad range of covered stents continues to be an unmet need in the field of congenital interventional cardiology.
Literature
1.
Bishnoi RN, Jones TK, Kreutzer J, Ringel RE. NuMED Covered Cheatham-Platinum Stent for the treatment or prevention of right ventricular outflow tract conduit disruption during transcatheter pulmonary valve replacement. Catheter Cardiovasc Interv. 2015;85(3):421–7.PubMedCrossRef
2.
• Delaney JW, Goldstein BH, Bishnoi RN, Bisselou KSM, McEnaney K, Minahan M, et al. Covered CP stent for treatment of right ventricular conduit injury during melody transcatheter pulmonary valve replacement results from the PARCS study. Circ Cardiovasc Interv. 2018;11(10). The authors report successful use of the Cheatham-Platinum (CP) covered stent for preventing or treating conduit disruption during preparation for transcatheter pulmonary valve implantation.
3.
Taggart NW, Minahan M, Cabalka AK, Cetta F, Usmani K, Ringel RE, et al. Immediate outcomes of covered stent placement for treatment or prevention of aortic wall injury associated with coarctation of the aorta (COAST II). JACC Cardiovasc Interv. 2016;9(5):484–93.PubMedCrossRef
4.
Tzifa A, Ewert P, Brzezinska-Rajszys G, Peters B, Zubrzycka M, Rosenthal E, et al. Covered Cheatham-platinum stents for aortic coarctation — early and intermediate-term results. J Am Coll Cardiol. 2006;47(7):1457–63.PubMedCrossRef
5.
6.
7.
Tanous D, Collins N, Dehghani P, Benson LN, Horlick EM. Covered stents in the management of coarctation of the aorta in the adult: initial results and 1-year angiographic and hemodynamic follow-up. Int J Cardiol. 2010;140(3):287–95.PubMedCrossRef
8.
Sohrabi B, Jamshidi P, Yaghoubi A, Habibzadeh A, Hashemi-aghdam Y, Moin A, et al. Comparison between covered and bare Cheatham-Platinum stents for endovascular treatment of patients with native post-ductal aortic coarctation immediate and intermediate-term results. JACC Cardiovasc Interv. 2014;7(4):416–23.PubMedCrossRef
9.
Hill KD, Goldstein BH, Angtuaco MJ, Chu PY, Fleming GA. Post-market surveillance to detect adverse events associated with Melody® valve implantation. Cardiol Young. 2017;27(6):1090–7.PubMedCrossRef
10.
Ewert P, Schubert S, Peters B, Abdul-Khaliq H, Nagdyman N, Lange PE. The CP stent - short, long, covered - for the treatment of aortic coarctation, stenosis of pulmonary arteries and caval veins, and Fontan anastomosis in children and adults: an evaluation of 60 stents in 53 patients. Heart. 2005;91(7):948–53.PubMedPubMedCentralCrossRef
11.
12.
Blais B, Carr K, Sinha SP, Salem MM, Levi DS. Mechanical properties of low-diameter balloon expandable covered stents. Catheter Cardiovasc Interv. 2021;97(3):451–8.PubMedCrossRef
13.
Cole JM, Salavitabar A, Armstrong AK, Berman DP. Use of the Gore Viabahn VBX balloon-expandable endoprosthesis in the congenital heart disease population. Catheter Cardiovasc Interv. 2019;94(3):416–21.PubMedCrossRef
14.
Hussein H, Walsh K. First in man use of the Advanta trademark V12 ePTFE-coated stent in aortic coarctation. Catheter Cardiovasc Interv. 2009;74(1):101–2.PubMedCrossRef
15.
Bruckheimer E, Birk E, Santiago R, Dagan T, Esteves C, Pedra CAC. Coarctation of the aorta treated with the Advanta V12 large diameter stent: acute results. Catheter Cardiovasc Interv. 2010;75(3):402–6.PubMed
16.
Schranz D, Jux C, Vogel M, Bauer J, Akintürk H, Valeske K. Large-diameter graft-stent (Advanta V12) implantation in various locations: early results. Cardiol Young. 2011;21(1):66–73.PubMedCrossRef
17.
Ohno N, Chaturvedi R, Lee KJ, Horlick EM, Osten MD, Benson LN. Experience with the Atrium Advanta covered stent for aortic obstruction. J Interv Cardiol. 2013;26(4):411–6.PubMedCrossRef
18.
Morgan GJ, Ciuffreda M, Spadoni I, DeGiovanni J. Optimus covered stent: advanced covered stent technology for complex congenital heart disease. Congenit Heart Dis. 2018;13(3):458–62.PubMedCrossRef
19.
Macdonald S, Thomas SM, Cleveland TJ, Gaines PA. Angioplasty or stenting in adult coarctation of the aorta? A retrospective single center analysis over a decade. Cardiovasc Intervent Radiol. 2003;26(4):357–64.PubMedCrossRef
20.
Zabal C, Attie F, Rosas M, Buendía-Hernández A, García-Montes JA. The adult patient with native coarctation of the aorta: balloon angioplasty or primary stenting? Heart. 2003;89(1):77–83.PubMedPubMedCentralCrossRef
21.
Pedra CAC, Fontes VF, Esteves CA, Pilla CB, Braga SLN, Pedra SRF, et al. Stenting vs. balloon angioplasty for discrete unoperated coarctation of the aorta in adolescents and adults. Catheter Cardiovasc Interv. 2005;64(4):495–506.
22.
Shaddy RE, Boucek MM, Sturtevant JE, Ruttenberg HD, Jaffe RB, Tani LY, et al. Comparison of angioplasty and surgery for unoperated coarctation of the aorta. Circulation. 1993;87(3):793–9.PubMedCrossRef
23.
Forbes TJ, Kim DW, Du W, Turner DR, Holzer R, Amin Z, et al. Comparison of surgical, stent, and balloon angioplasty treatment of native coarctation of the aorta: an observational study by the CCISC (Congenital Cardiovascular Interventional Study Consortium). J Am Coll Cardiol. 2011;58(25):2664–74.PubMedCrossRef
24.
Cowley CG, Orsmond GS, Feola P, McQuillan L, Shaddy RE. Long-term, randomized comparison of balloon angioplasty and surgery for native coarctation of the aorta in childhood. Circulation. 2005;111(25):3453–6.PubMedCrossRef
25.
Isner JM, Donaldson RF, Fulton D, Bhan I, Payne DD, Cleveland RJ. Cystic medial necrosis in coarctation of the aorta: a potential factor contributing to adverse consequences observed after percutaneous balloon angioplasty of coarctation sites. Circulation. 1987;75(4):689–95.PubMedCrossRef
26.
Tanous D, Benson LN, Horlick EM. Coarctation of the aorta: evaluation and management. Curr Opin Cardiol. 2009;24(6):509–15.PubMedCrossRef
27.
Chakrabarti S, Kenny D, Morgan G, Curtis SL, Hamilton MC, Wilde P, et al. Balloon expandable stent implantation for native and recurrent coarctation of the aorta–prospective computed tomography assessment of stent integrity, aneurysm formation and stenosis relief. Heart. 2010;96(15):1212–6.PubMedCrossRef
28.
Varma C, Benson LN, Butany J, McLaughlin PR. Aortic dissection after stent dilatation for coarctation of the aorta: a case report and literature review. Catheter Cardiovasc Interv. 2003;59(4):528–35.PubMedCrossRef
29.
Tan J-L, Mullen M. Emergency stent graft deployment for acute aortic rupture following primary stenting for aortic coarctation. Catheter Cardiovasc Interv. 2005;65(2):306–9.PubMedCrossRef
30.
Alcibar J, Peña N, Inguanzo R, Arriola MJ, Garcia K, Eguia I, et al. Stent-graft deployment for aortic rupture after stenting for aortic recoarctation. Tex Heart Inst J. 2007;34(4):453–6.PubMedPubMedCentral
31.
Pedra CAC, Fontes VF, Esteves CA, Arrieta SR, Braga SLN, Justino H, et al. Use of covered stents in the management of coarctation of the aorta. Pediatr Cardiol. 2005;26(4):431–9.PubMedCrossRef
32.
Qureshi SA, Zubrzycka M, Brzezinska-Rajszys G, Kosciesza A, Ksiazyk J. Use of covered Cheatham-Platinum stents in aortic coarctation and recoarctation. Cardiol Young. 2004;14(1):50–4.PubMedCrossRef
33.
Butera G, Piazza L, Chessa M, Negura DG, Rosti L, Abella R, et al. Covered stents in patients with complex aortic coarctations. Am Heart J. 2007;154(4):795–800.PubMedCrossRef
34.
35.
Ringel RE, Vincent J, Jenkins KJ, Gauvreau K, Moses H, Lofgren K, et al. Acute outcome of stent therapy for coarctation of the aorta: results of the coarctation of the aorta stent trial. Catheter Cardiovasc Interv. 2013;82(4):503–10.PubMed
36.
•• Holzer RJ, Gauvreau K, McEnaney K, Watanabe H, Ringel R. Long-term outcomes of the coarctation of the aorta stent trials. Circ Cardiovasc Interv. 2021;14(6):e010308. Despite excellent short-term results after coarctation stenting, 25% of patients in the combined COAST (bare-metal CP stent) and COAST II (covered CP stent) group had undergone reintervention by late follow-up.
37.
Hekim Yılmaz E, Bulut MO, Küçük M, Yücel İK, Erdem A, Çelebi A. Use of covered stents in simultaneous management of coarctation of the aorta and patent ductus arteriosus. Anatol J Cardiol. 2018;19(4):332–6.PubMed
38.
Stassen J, De Meester P, Troost E, Roggen L, Moons P, Gewillig M, et al. Covered stent placement for treatment of coarctation of the aorta: immediate and long-term results. Acta Cardiol. 2020:1–9.
39.
• Al Balushi A, Pascall E, Jones MI, Qureshi S, Butera G. Initial experience with a novel ePTFE-covered balloon expandable stent in patients with near-atretic or severe aortic coarctation and small femoral arterial access. Cardiol Young. 2021;31(2):224-8. This small case series reports early results of a novel, low-profile, balloon expandable covered stent for use in treating coarctation of the aorta.
40.
Sasikumar D, Sasidharan B, Rashid A, Ayyappan A, Goplakrishnan A, Krishnamoorthy KM, et al. Early and late outcome of covered and non-covered stents in the treatment of coarctation of aorta — a single centre experience. Indian Heart J. 2020;72(4):278–82.PubMedPubMedCentralCrossRef
41.
Ewert P, Abdul-Khaliq H, Peters B, Nagdyman N, Schubert S, Lange PE. Transcatheter therapy of long extreme subatretic aortic coarctations with covered stents. Catheter Cardio Inte. 2004;63(2):236–9.CrossRef
42.
Tufaro V, Butera G. Chetham-platinum-covered stent, aortic coarctation, and left subclavian artery: sometimes is there one too many? Cardiol Young. 2019;29(10):1302–4.PubMedCrossRef
43.
Rothman A, Ciccolo ML, Galindo A, Evans WN. Left subclavian artery test balloon occlusion before covered stent for recoarctation and aneurysm. World J Pediatr Cong. 2020;11(4):Np235-Np8.
44.
Zahn EM, Hellenbrand WE, Lock JE, McElhinney DB. Implantation of the melody transcatheter pulmonary valve in patients with a dysfunctional right ventricular outflow tract conduit early results from the u.s. Clinical trial. J Am Coll Cardiol. 2009;54(18):1722–9.
45.
McElhinney DB, Hellenbrand WE, Zahn EM, Jones TK, Cheatham JP, Lock JE, et al. Short- and medium-term outcomes after transcatheter pulmonary valve placement in the expanded multicenter US Melody valve trial. Circulation. 2010;122(5):507-U132.PubMedPubMedCentralCrossRef
46.
McElhinney DB, Cheatham JP, Jones TK, Lock JE, Vincent JA, Zahn EM, et al. Stent fracture, valve dysfunction, and right ventricular outflow tract reintervention after transcatheter pulmonary valve implantation patient-related and procedural risk factors in the US Melody valve trial. Circ Cardiovasc Interv. 2011;4(6):602-U130.PubMedCrossRef
47.
Lurz P, Coats L, Khambadkone S, Nordmeyer J, Boudjemline Y, Schievano S, et al. Percutaneous pulmonary valve implantation: impact of evolving technology and learning curve on clinical outcome. Circulation. 2008;117(15):1964–72.PubMedCrossRef
48.
Bonhoeffer P, Boudjemline Y, Saliba Z, Merckx J, Aggoun Y, Bonnet D, et al. Percutaneous replacement of pulmonary valve in a right-ventricle to pulmonary-artery prosthetic conduit with valve dysfunction. Lancet. 2000;356(9239):1403–5.PubMedCrossRef
49.
Hainstock MR, Marshall AC, Lock JE, McElhinney DB. Angioplasty of obstructed homograft conduits in the right ventricular outflow tract with ultra-noncompliant balloons assessment of therapeutic efficacy and conduit tears. Circ Cardiovasc Interv. 2013;6(6):671–9.PubMedCrossRef
50.
Kostolny M, Tsang V, Nordmeyer J, Van Doorn C, Frigiola A, Khambadkone S, et al. Rescue surgery following percutaneous pulmonary valve implantation. Eur Cardiothorac Surg. 2008;33(4):607–12.CrossRef
51.
Zahn EM, Hellenbrand WE, Lock JE, McElhinney DB. Implantation of the Melody transcatheter pulmonary valve in patients with a dysfunctional right ventricular outflow tract conduit early results from the US clinical trial. J Am Coll Cardiol. 2009;54(18):1722–9.PubMedCrossRef
52.
Nordmeyer J, Khambadkone S, Coats L, Schievano S, Lurz P, Parenzan G, et al. Risk stratification, systematic classification, and anticipatory management strategies for stent fracture after percutaneous pulmonary valve implantation. Circulation. 2007;115(11):1392–7.PubMedCrossRef
53.
Eicken A, Ewert P, Hager A, Peters B, Fratz S, Kuehne T, et al. Percutaneous pulmonary valve implantation: two-centre experience with more than 100 patients. Eur Heart J. 2011;32(10):1260–5.PubMedCrossRef
54.
Armstrong AK, Balzer DT, Cabalka AK, Gray RG, Javois AJ, Moore JW, et al. One-year follow-up of the melody transcatheter pulmonary valve multicenter post-approval study. JACC Cardiovasc Interv. 2014;7(11):1254–62.PubMedCrossRef
55.
Cabalka AK, Hellenbrand WE, Eicken A, Kreutzer J, Gray RG, Bergersen L, et al. Relationships among conduit type, pre-stenting, and outcomes in patients undergoing transcatheter pulmonary valve replacement in the prospective North American and European Melody Valve Trials. JACC Cardiovasc Interv. 2017;10(17):1746–59.PubMedCrossRef
56.
Cheatham JP. Stenting of coarctation of the aorta. Catheter Cardiovasc Interv. 2001;54(1):112–25.PubMedCrossRef
57.
Kenny DP, Hijazi ZM. COAST-ing toward covered stents for aortic coarctation: not all plain sailing! JACC Cardiovasc Interv. 2016;9(5):494–5.PubMedCrossRef
Metadata
Title
Covered Stents in the Management of Aortic Coarctation and Right Ventricular Outflow Tract Obstruction
Authors
Nibras E. El Sherif
Nathaniel W. Taggart
Publication date
01-01-2022
Publisher
Springer US
Published in
Current Cardiology Reports / Issue 1/2022
Print ISSN: 1523-3782
Electronic ISSN: 1534-3170
DOI
https://doi.org/10.1007/s11886-021-01623-y

Other articles of this Issue 1/2022

Current Cardiology Reports 1/2022 Go to the issue

Hypertension (DS Geller and DL Cohen, Section Editors)

Pseudopheochromocytoma: an Uncommon Cause of Severe Hypertension

New Therapies for Cardiovascular Disease (AA Bavry and MR Massoomi, Section Editors)

Rilonacept (Interleukin-1 Inhibition) for the Treatment of Pericarditis

Correction

Correction to: Rilonacept (Interleukin‑1 Inhibition) for the Treatment of Pericarditis

Ischemic Heart Disease (D Mukherjee, Section Editor)

The Enhanced Cardiac Outcome of Conjugated SGLT2 Inhibitors and GLP-1RA Therapy in Diabetic Patients

Valvular Heart Disease (TL Kiefer, Section Editor)

Treatment of Bicuspid Aortic Valve Stenosis with TAVR: Filling Knowledge Gaps Towards Reducing Complications

Stroke (DL Tirschwell, Section Editor)

Updates in Cerebral Venous Thrombosis