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  • Title: Stenting complex aortic arch obstructions.
    Author: Holzer RJ, Chisolm JL, Hill SL, Cheatham JP.
    Journal: Catheter Cardiovasc Interv; 2008 Feb 15; 71(3):375-82. PubMed ID: 18288730.
    Abstract:
    OBJECTIVE: To present our institutional experience of endovascular stent therapy in patients with complex aortic arch lesions. BACKGROUND: The management of aortic arch obstructions is complex and many physicians are either reluctant to treat mild-moderate aortic arch lesions associated with systemic hypertension or instead refer to high-risk surgical alternatives. Reported data on transcatheter stent therapy of complex aortic arch lesions are scarce. METHODS: Between October 2002 and November 2006, 40patients (pts) had complex aortic arch lesions treated with stent implantation in 42 procedures (proc). Aortic arch hypoplasia was present in 30/42 proc (71.4%). The median age was 10 year (16 days - 37 years). In 40/42 proc (95.2%) patients had previous transcatheter or surgical aortic arch interventions. RESULTS: Procedural success in achieving a peak systolic gradient reduction to <or=10 mm Hg with an improvement in the diameter to >or=90% of the "normal" adjacent aortic arch was achieved in 38/42 proc (90.5%). The diameter of the arch obstruction increased from a median of 7.55 mm to a median of 14 mm (P < 0.0001) and the peak systolic gradient was reduced from a median of 23 mm Hg to a median of 2 mm Hg (P < 0.0001). Arch vessels were crossed in 31/42 proc (73.8%). Periprocedural adverse events were encountered in 13/42 proc (30.9%), predominately in patients with a weight below 10 kg or univentricular physiology. The median follow-up was 1 year (32 days - 3.8 years). The incidence of systemic hypertension was significantly reduced from 22/42 (52.4%) before the procedure to 6/39 (15.4%) at the most recent follow-up (P = 0.0005). CT or MRI evaluations were performed in 18 pts, documenting all crossed arch vessels to appear patent. CONCLUSIONS: Stenting of complex aortic arch lesions can be performed safely and effectively with excellent, immediate, and midterm results. Patients with a weight below 10 kg or after Hybrid stage I palliation are at increased risk of adverse events. Stents can be placed across major arch vessels without compromising distal perfusion in otherwise normal vasculature.
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