Percutaneous Balloon-Expandable Stent Implantation to Treat Transverse Aortic Arch Obstruction: Medium- to Long-Term Outcomes of a Retrospective Multicenter Study.

Background: Transverse aortic arch obstruction is a challenging lesion for which stent implantation provides a potentially important alternate therapy. The objectives were to evaluate the technical, procedural, and medium-to-long-term clinical outcomes of percutaneous stent implantation of transverse aortic arch obstruction.
Methods: This is a retrospective, multicenter study of transverse aortic arch stent implantation. Univariable and multivariable analyses were performed.
Results: Index catheterization included 187 stent implants in 146 patients. The median age is 14.3 years (interquartile range, 9.3-19), weight is 53 kg (30-69), and follow-up is 53 months (12-120). The most common stent design was open cell (n=90, 48%). Stents overlapped 142 arch vessels (37 carotid arteries) in 118 (81%) cases. Technical and procedural success rates were 100% and 88%, respectively. Lower weight ( P =0.018), body surface area ( P =0.013), and minimum-to-descending aortic diameter ratio ( P <0.001) were associated with higher baseline aortic gradient. The residual gradient was inversely associated with implant and final dilation diameters ( P <0.001). The combined incidence of aortic injury and stent-related complications was 14%. There were no reports of abnormal brain scans or stroke. Blood pressure cuff gradient, echocardiographic arch velocity, and hypertension rates improved within 1-year follow-up with increased antihypertensive medication use. Reintervention was reported in 60 (41%) patients at a median of 84 (22-148) months to first reintervention. On multivariable logistic regression, residual aortic gradient >10 mm Hg was associated with increased odds of reintervention at all time points when controlling for each final dilation diameter, weight, and minimum-to-descending aortic diameter ratio.
Conclusions: Transverse aortic arch stent implantation has high rates of technical, procedural, and medium-to-long-term clinical success. Aortic gradient >10 mm Hg is associated with increased odds of reintervention at 1-year and most recent follow-ups. Open cell stent design was frequently used for its advantages in conformability, perfusion of arch vessels, low fracture rate, and the ability to perform effective angioplasty of side cells.
Competing Interests: Dr Armstrong is a consultant for Abbott, Medtronic, Edwards Lifesciences, Cook Medical, Starlight Cardiovascular, and B. Braun Interventional Systems and received research support from Edwards Lifesciences, Renata Medical, and atHeart Medical. Dr Boe is a consultant at Abbott and Medtronic. Dr Cheatham is a consultant, a proctor, and a principal investigator at Medtronic; a consultant at NuMED; a consultant and a proctor at Beijing Med-Zenith Medical Technology Co; a data monitoring committee at Autus Valve Technologies; on the data safety monitoring board at Xeltis; and received research support from Xeltis and Med-Zenith Medical Technology Co. Dr Jones is an investigator, a consultant, and a proctor at Medtronic; an investigator and a consultant at Edwards; an investigator, a consultant, and a proctor at Abbott; and an investigator, a consultant, and a proctor at W. L. Gore. Dr Morray is a proctor at Medtronic and Abbott. Dr Steinberg is a proctor and a consultant at Medtronic, Gore Medical, Abbott, and B. Braun. Dr Berman is a proctor and a consultant at Abbott, B. Braun, Medtronic, and Edwards Lifesciences. The other authors report no conflicts.