Boshoff D et al. (2006) Stenting of hypoplastic aortic segments with mild pressure gradients and arterial hypertension. Heart [doi: 10.1136/hrt.2005.084822]

Residual hypoplasia of the aortic cross or isthmus is a common outcome of coarctectomy. Narrowing of the lumen can lead to hypertension, and associated morbidity and mortality are high in long-term follow-up. Although patients with mild residual hypoplasia have a raised risk of cardiovascular disease, these patients would not be considered for surgical intervention because the risks of surgical correction are felt to outweigh the potential benefits. Boshoff et al. evaluated the efficacy of stent expansion in treating hypoplasia of the aortic cross or isthmus in 20 patients with arterial hypertension and aortic hypoplasia, 17 of whom had previously undergone coarctectomy.

In total, 23 stents were implanted; three patients required stenting of both the cross and the isthmus. Following surgery, the median systolic gradient across the aortic arch decreased from 17 mmHg to 1 mmHg, and the mean diameter of the affected segment increased from 10 mm to 17 mm. At 1 month, mean systolic blood pressure had decreased from 141 mmHg to 128 mmHg. Arterial hypertension resolved in 12 patients, and those remaining on medication were either taking greatly reduced doses or had improved blood pressure control. The subclavian artery was crossed in four patients, who had no complications during follow-up of 0.6–3.3 years.

Stenting of the hypoplastic segment would therefore seem to be a safe and effective means of correcting aortic hypoplasia and of reducing or eliminating hypertension in patients with this condition.