Clinical Research
Systemic Blood Pressure After Stent Management for Arch Coarctation Implications for Clinical Care

https://doi.org/10.1016/j.jcin.2012.10.009Get rights and content
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Objectives

The goal of this study was to prospectively assess blood pressure (BP) and echocardiographic parameters to delineate the incidence and nature of the hypertension burden in this cohort.

Background

Few data are available on the long-term outcomes of aortic stenting.

Methods

Thirty-one patients with successfully stented coarctation during childhood (mean age 12.4 years) underwent 24-h ambulatory BP monitoring (ABPM), exercise BP measurement, and echocardiographic assessment.

Results

Mean time after stent implantation was 5.3 ± 4 years. Hypertension was noted on one-off right-arm BP assessment in 3 patients (10%), but on the basis of the 24-h ABPM assessment in 14 patients (45%). Twenty-four of 31 patients (80%) had an abnormally elevated exercise BP response. Peak exercise BP correlated with left ventricular mass index (r = 0.51; p < 0.05), which was also significantly increased in the entire cohort (mean = 91.3 g/m2; p < 0.05). In patients with significant somatic growth since implantation, the indexed diameter of the stent (to aortic diameter) had significantly decreased from the 48th percentile at the implantation to the 4th percentile during the study (p < 0.05). There was no difference in any parameter between patients with native or those with recurrent coarctation.

Conclusions

Hypertension is endemic in patients with stented coarctation, irrespective of the absence of residual obstruction. Due to abnormal BP homeostasis, hypertension should be aggressively pursued by ABPM assessment and exercise stress testing in this population. Relative hypoplasia of the stented arch after somatic growth may contribute to this tendency and should provoke consideration of elective serial redilation of coarctation stents.

Key Words

coarctation of the aorta
endovascular stent
interventional cardiology
systemic hypertension

Abbreviations and Acronyms

ABPM
ambulatory blood pressure monitoring
BP
blood pressure
BSA
body surface area
CoA
coarctation of the aorta
ECG
electrocardiography
EIH
exercise-induced hypertension
ET
exercise testing
LVMI
indexed left ventricular mass
MASBP
mean ambulatory systolic blood pressure
naCoA
native coarctation
reCoA
recurrent coarctation

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Dr. Lee is a consultant for Abbott Canada. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.