Contemporary Outcomes Following Endovascular Therapy of Coarctation of Aorta- Experience from a Tertiary Care Centre in India

Introduction: Since 1980s, endovascular therapy has evolved as an important therapeutic strategy for Coarctation of the Aorta (CoA). Aim: This study sought to present a comprehensive contemporary data on the efficacy and safety of endovascular therapy in all age groups with both native and recurrent CoA in patients presenting to a tertiary care centre in Southern India. Materials and Methods: This single centre retrospective study included 91 consecutive patients who underwent Balloon Angioplasty (BA) or stenting for CoA between November 2002 and October 2017. Clinical, angiographic and procedural data was collected and outcomes including procedural success, complications, incidence of re-stenosis and hypertension at follow-up were evaluated. The effect of pre-specified variables on the procedural result was also evaluated using chi-square or two sample t-test, as appropriate. Results: Of the 91 patients, 63 were males; median age was 20 years {interquartile range (IQR):11-29}. The median followup duration was 17 months (IQR -7.5 to 36 months). Eighty four (92%) cases were with native coarctation. Fifty five (60%) had discrete coarctation and 36 (40%) had associated tubular hypoplasia of isthmus. Seventy two (79%) patients underwent stent implantation and 19 (21%) underwent BA. Immediate procedural success was achieved in 68 (94%) patients in the stent implantation group and 13 (68%) patients in BA group. Sixty percent of the failures were from BA group. Twelve (18%) patients had re-obstruction on follow-up. Seven (11%) patients underwent re-intervention. Conclusion: Endovascular therapy is a relatively safe and effective treatment modality in CoA when done carefully at experienced centres and in appropriately selected patients.