Covered Cheatham-Platinum Stent Effective for Acute Wall Injury Associated With Coarctation of the Aorta

Covered Cheatham-Platinum stent (CCPS) was effective at treating and potentially preventing acute wall injury (AWI) associated with the coarctation of the aorta, according to results from the COAST II study (Covered Cheatham-Platinum Stents for Prevention or Treatment of Aortic Wall Injury Associated with Coarctation of the Aorta Trial).

Coarctation of the aorta, which makes up 5 % to 8% of congenital heart disease, may not be detected until late childhood or adulthood. Balloon angioplasty may lead to AWI and recurrent obstruction, which has led to the “off-label” use of bare metal stents in older patients. While these treatments are considered to be generally safe, aortic dissection, aneurysm, and rupture have occurred, especially with severe or complex lesions.

COAST II investigators enrolled 158 patients (65% male; median age: 19 years) from 19 pediatric cardiac centers to undergo CCPS (NuMED, Inc; Hopkinton, NY) placement. Pre-existing AWI was present in 83 patients. Of these treatment group patients, 71 were treated with a single CCPS and 93% (n=66) achieved complete coverage of pre-existing AWI. Only a few patients had minor endoleaks, but no repeat intervention was required.

Overall, there were no deaths, repeat interventions, or acute AWI.

In addition, the prevention group had a greater ascending-descending aorta gradient (36 ± 20 mm Hg vs 19 ± 15 mm Hg; P<.0001) and tighter coarctation of the aorta (5 ± 4 vs 10 ± 4; P<.0001). The average gradient improved from 27 ± 20 mm Hg to 4 ± 6 mm Hg.

Hospital stays were short (median length: 1 day for the entire cohort) and only 13 patients experienced serious or somewhat serious adverse events. Antiplatelet therapy or anticoagulation was continued for at least 6 months post-procedure, depending on the patient’s prior treatment.

“Once considered a surgical disease, CoA [coarctation of the aorta] can now frequently be managed via minimally invasive catheter-based methods,” the authors concluded. “Placement of the CCPS has a high rate of technical success and short-term hemodynamic improvement.”

However, researchers acknowledged that “longer-term data are necessary and are forthcoming to describe the durability of the CCPS and incidence of aneurysm formation after stent implantation.”

Reference

Taggart NW, Minahan M, Cabalka AK, et al; on behalf of the COAST II Investigators. 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. doi: 10.1016/j.jcin.2015.11.038.