Editorial Comment

Large Diameter Covered StentTreatment of Aortic Coarctation

Victor Lucas,* MD, FSCAISection Head Pediatric CardiologyInterventional Pediatric cardiologyOchsner Clinic FoundationNew Orleans, Louisiana

INTRODUCTION

In this article, Carlos Pedra and his colleagues presentan exceptionally fine review of their collective acute ex-perience with elective large diameter covered stent treat-ment of thoracic aortic coarctation and localized aneur-ysms associated with prior catheter interventions.

The stent placement procedures were successful inevery measurable way in 25 patients. No complicationswere reported. The authors were meticulous in theirapproach to vascular access and assessment of vesseladequacy. Closure devices were not used.

The Advanta V 12 system used is low profile com-pared to others and was used successfully throughsheaths as small as 8F.

The authors note that PTFE covered stents exhibitmore acute recoil than uncovered stents. While the ex-perience described herein is satisfactory, a few wordsof caution are in order before ‘‘generalizing’’ thesedata.The recoil inherent to balloon-expandable covered

stents is a potentially serious disadvantage comparedto self-expanding covered stents in the treatment ofvessel rupture. Late rebleeding with disastrous resultscan occur with balloon expanded stents in this setting.Stent embolization was not encountered in this

report. The authors pointedly mention their approachto minimizing embolization risk. It is expected thatembolization of a covered stent will carry significantlymore risk than with uncovered stents. These electiveprocedures should be carried out by operators with sig-nificant stent repositioning and retrieval experience andwith surgical back-up.As the authors note, the long-term integrity of the

Advanta V 12 stent and its covering in the thoracicaorta is not yet known.Dr. Pedra and his colleagues are to be commended

for their work as reported. Much remains to be learnedabout the optimal treatment for aortic coarctation andassociated complications.

Conflict of interest: Nothing to report.

*Correspondence to: Dr. Victor Lucas, Section Head Pediatric Car-

diology, Interventional Pediatric Cardiology, Ochsner Clinic Founda-

tion, 1315 Jefferson Hwy., New Orleans, LA 70121.

E-mail: vlucas@ochsner.org

Received 23 December 2009; Revision accepted 30 December 2009

DOI 10.1002/ccd.22441

Published online 16 February 2010 in Wiley InterScience (www.

interscience.wiley.com).

' 2010 Wiley-Liss, Inc.

Catheterization and Cardiovascular Interventions 75:407 (2010)