Benefit of endovascular stenting for aortic coarctation on systemic hypertension in adults

Arch Cardiovasc Dis. 2015 Dec;108(12):626-33. doi: 10.1016/j.acvd.2015.06.008. Epub 2015 Oct 27.

Abstract

Background: Endovascular stenting is a recognised treatment strategy for aortic coarctation (CoA) in adults. We assessed systemic hypertension control and the need for antihypertensive therapy after CoA stenting in adults.

Methods: Data were collected prospectively on 54 patients (36 men; mean age: 34 ± 16 years) who underwent endovascular stenting for CoA over a 7-year period. Five patients were excluded as they did not attend follow-up appointments. Patients underwent clinical examination, including right arm systolic blood pressure (SBP) and 24-hour ambulatory blood pressure monitoring at baseline, 6-12 weeks and 9-12 months.

Results: There was a significant fall in mean peak-to-peak systolic gradient (PG) across the CoA after stenting (26 ± 11 mmHg vs. 5 ± 4 mmHg; P<0.01). There were successive reductions in right arm SBP and ambulatory SBP at baseline, 6-12 weeks and 9-12 months post-procedure (right arm: 155 ± 18 mmHg vs. 137 ± 17 mmHg vs. 142 ± 16 mmHg, respectively; all P-values <0.01; ambulatory: 142 ± 14 mmHg vs. 132 ± 16 mmHg vs. 131 ± 15 mmHg, respectively; all P-values <0.01). Twenty-four patients had severe CoA (PG >25 mmHg before stenting); baseline SBP was significantly higher in severe versus non-severe patients (160 mmHg vs. 148 mmHg; P=0.02). The absolute reduction in PG after stenting was significantly higher in the severe group (31 ± 7 mmHg vs. 14 ± 5 mmHg; P<0.0001), but there was no significant difference in SBP between groups at 6-12 weeks (141 mmHg vs. 135 mmHg; P=0.21) or 9-12 months (139 mmHg vs. 139 mmHg; P=0.96).

Conclusion: Endovascular stenting of CoA results in a significant reduction in SBP at 6-12 weeks, which is sustained at 9-12 months, with similar outcomes in severe and non-severe CoA groups.

Keywords: Aortic coarctation; Coarctation aortique; Coarctation stenting; Hypertension artérielle systématique; Stenting pour coarctation; Systemic hypertension.

Publication types

  • Observational Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aortic Coarctation / complications
  • Aortic Coarctation / physiopathology
  • Aortic Coarctation / surgery*
  • Blood Pressure / physiology*
  • Blood Pressure Monitoring, Ambulatory / methods*
  • Blood Vessel Prosthesis*
  • Endovascular Procedures / methods*
  • Female
  • Follow-Up Studies
  • Humans
  • Hypertension / complications
  • Hypertension / physiopathology*
  • Hypertension / surgery
  • Male
  • Middle Aged
  • Prospective Studies
  • Stents*
  • Time Factors
  • Treatment Outcome
  • Young Adult