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A case of AndraStent® fracture in a patient with aortic coarctation: a review of the literature

Published online by Cambridge University Press:  09 June 2020

Giulio Cabrelle Open the ORCID record for Giulio Cabrelle [Opens in a new window] ,
Ornella Milanesi  and
Biagio Castaldi
Giulio Cabrelle*
Affiliation:
Pediatric Cardiology, Department of Women’s and Children’s Health, University of Padua, Padova, Italy
Ornella Milanesi
Affiliation:
Pediatric Cardiology, Department of Women’s and Children’s Health, University of Padua, Padova, Italy
Biagio Castaldi
Affiliation:
Pediatric Cardiology, Department of Women’s and Children’s Health, University of Padua, Padova, Italy
*
Author for correspondence: Giulio Cabrelle, MD, via Giustiniani 2, 35128Padova, Italy. Tel: +39 3494361936, +39 0498213558; Fax: +39 049 8213502. E-mail: giulio.cabrelle@gmail.com
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Abstract

Percutaneous treatment of aortic coarctation is based on angioplasty and/or stenting of the isthmus. We report a case of a 28-year-old girl suffering from aortic coarctation syndrome (coarctation + ventricular septal defect + bicuspid aorta). She underwent coarctectomy with subclavian flap and pulmonary bandage followed by ventricular septal defect closure and bandage removal in her first year of life. When she was 27 years old, a follow-up echocardiography detected an isthmic pressure gradient and a demodulated Doppler in abdominal aorta. A cardiac catheterisation confirmed the diagnosis of aortic re-coarctation. An AndraStent® XL 48 mm was implanted with a resolution of the isthmic gradient. One year later, because of the reappearance of demodulated Doppler in abdominal aorta, a chest X-ray was performed, which showed a stent third-grade fracture. The fracture was corrected by positioning a covered stent cheatham platinum 45 mm through the fragments. The rarest complication after stenting procedures is the fracture of the device with an incidence between 0.01% and 0.08%. Pressure overload beyond the elastic threshold of the material and the pulsatile tension exerted by the blood flow on the walls of the stent are the main mechanisms at the base of the fracture, together with the compliance of the tissue. A vessel that underwent multiple surgical rearrangements could interfere with and complicate the physiopathology at the basis of the fracture. In conclusion, stenting is a safe technique to treat aortic coarctation; stent fracture is a rare event, and different anatomical and haemodynamic factors are related to this complication.

Keywords

Aortic coarctationstentstent fractureCHDheart catheterisation
Type
Brief Report
Information
Cardiology in the Young , Volume 30 , Issue 7 , July 2020 , pp. 1035 - 1038
Copyright
© The Author(s), 2020. Published by Cambridge University Press

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References

Breinholt, JP, Nugent, AW, Law, MA, Justino, H, Mullins, CE, Ing, FF. Stent fractures in congenital heart disease. Catheter Cardiovasc Interv 2008; 72: 977–982.10.1002/ccd.21742CrossRefGoogle ScholarPubMed
Chakrabarti, S, 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: 1212–1216.10.1136/hrt.2009.170928CrossRefGoogle ScholarPubMed
Carrozza, M, et al.Stress stent fracture: is stent angioplasty really a safe therapeutic option in native aortic coarctation? Int J Cardiol 2006; 113: 127–128.10.1016/j.ijcard.2005.08.041CrossRefGoogle ScholarPubMed
Thanopoulos, BD. Initial and six-year results of stent implantation for aortic coarctation in children. Am J Cardiol 2012; 109: 1499–1503.10.1016/j.amjcard.2012.01.365CrossRefGoogle ScholarPubMed
Butera, G, et al.From bare to covered: 15-year single center experience and follow-up in trans-catheter stent implantation for aortic coarctation. Catheter Cardiovasc Interv 2014; 83: 953–963.10.1002/ccd.25404CrossRefGoogle ScholarPubMed
Qureshi, AM, McElhinney, DB, Lock, JE, Landzberg, MJ, Lang, P, Marshall, AC. Acute and intermediate outcomes, and evaluation of injury to the aortic wall, as based on 15 years experience of implanting stents to treat aortic coarctation. Cardiol Young 2007; 17: 307–318.10.1017/S1047951107000339CrossRefGoogle ScholarPubMed
Chessa, M, et al.Results and mid-long term follow up of stent implantation for native and recurrent coarctation of the aorta. Eur Heart J 2005; 26: 2728–2732.10.1093/eurheartj/ehi491CrossRefGoogle ScholarPubMed
Golden, AB, et al.Coarctation of the aorta: stenting in children and adults. Catheter Cardiovasc Interv 2007; 69: 289–299.10.1002/ccd.21009CrossRefGoogle ScholarPubMed
McElhinney, DB, et al.Fracture of cardiovascular stents in patients with congenital heart disease theoretical and empirical considerations. Circ Cardiovasc Interv 2013; 6: 575–585.10.1161/CIRCINTERVENTIONS.113.000148CrossRefGoogle ScholarPubMed
Fiszer, R, Bialkowski, J, Chodór, B, Pawlak, S, Szkutnik, M.Use of the AndraStent XL and XXL for the treatment of coarctation of the aorta in children and adults: immediate and midterm results. Eurointerventions 2016; 12: 394–399.10.4244/EIJY15M06_03CrossRefGoogle ScholarPubMed