Vol. 29 No. 3 (2025): Patologiya krovoobrashcheniya i kardiokhirurgiya
CASE REPORTS

Modern possibilities of stenting aortic coarctation in adults: analysis of clinical observations

pdf (Русский)
  • Aleksandra A. Rumiantseva,
  • Pavel A. Shushpannikov,
  • Roman S. Tarasov
Aleksandra A. Rumiantseva
Research Institute for Complex Issues of Cardiovascular Diseases
Pavel A. Shushpannikov
Research Institute for Complex Issues of cardiovascular diseases
Bio
Roman S. Tarasov
Research Institute for Complex Issues of cardiovascular diseases
Bio
DOI: https://doi.org/10.21688/1681-3472-2025-3-58-68

Published 2025-12-18

How to Cite

Rumiantseva, A. A., Shushpannikov, P. A., & Tarasov, R. S. (2025). Modern possibilities of stenting aortic coarctation in adults: analysis of clinical observations. Patologiya Krovoobrashcheniya I Kardiokhirurgiya, 29(3), 58–68. https://doi.org/10.21688/1681-3472-2025-3-58-68

Copyright (c) 2025 Александра Александровна Румянцева, Павел Андреевич Шушпанников, Роман Сергеевич Тарасов

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Abstract

Background: Coarctation of the aorta occurs in newborns as a primary condition, and in most cases it is critical and associated with other congenital heart defects. Besides, coarctation of the aorta may be first detected in older children, adolescents, and adults; this pathology is diagnosed both as an isolated heart defect and in combination with other heart defects (congenital or acquired), or as a consequence of restenosis of a previously operated aorta. In the adults, coarctation of the aorta is often associated with severe comorbidities and decompensated conditions, such as decreased left ventricular myocardial contractility, congestive heart failure, and high pulmonary hypertension. The choice of surgical tactics in such patients remains controversial; although in case of native coarctation of the aorta, as well as in the case of recoarctation, if technically feasible, stenting is considered the preferred method of choice in many specialized centers.

Objective: The study aimed to present clinical experience of involving endovascular methods for correction of coarctation of the aorta in adult patients using a series of four cases as an example.

Methods: From 2021 to 2025, specialists of our clinical unit performed aortic coarctation stenting in four adult patients, aged 26 to 51 years, with comorbidities. In all cases, the chosen tactic was stenting of aortic coarctation by puncture access through the common femoral artery on the right under local anesthesia.

Results: All patients had been under long-term monitoring for hypertension with no positive effect achieved due to high doses of antihypertensive medications. Further examinations revealed a congenital heart defect: coarctation of the aorta. Due to the severity of the condition in three cases and at the patient’s request in one case, all of them underwent stenting of the coarctation of the aorta. The postoperative period was without complications, and a positive effect was noted immediately after the procedure. In two cases, no recurrence of aortic restenosis was recorded during a three-year follow-up.

Conclusion: Stenting of aortic coarctation in adult patients is currently the method of choice, offering high safety and efficacy, with advantages over open surgical interventions in terms of the degree of trauma and rehabilitation timeframe.

pdf (Русский)

References

  1. Коарктация аорты: клинические рекомендации – 2023. URL: https://cr.minzdrav.gov.ru/preview-cr/754_1?ysclid=m5uouc uhv1773760690
  2. Coarctation of aorta: clinical recommendations – 2023. (In Russ.) URL: https://cr.minzdrav.gov.ru/preview-cr/754_1?ysclid=m5 uoucuhv1773760690
  3. Baumgartner H., De Backer J., Babu-Narayan S.V., Budts W., Chessa M., Diller G.P., Lung B., Kluin J., Lang I.M., Meijboom F., Moons P., Mulder B.J.M., Oechslin E., Roos-Hesselink J.W., Schwerzmann M., Sondergaard L., Zeppenfeld K. ESC Scientific Document Group. 2020 ESC Guidelines for the management of adult congenital heart disease. Eur Heart J. 2021;42(6):563-645. PMID: 32860028. https://doi.org/10.1093/eurheartj/ehaa554
  4. Ильин А.С., Теплов П.В., Сакович В.А. Коарктация аорты как патология сердечно-сосудистой системы. Наши возможности в хирургии. Сибирское медицинское обозрение. 2018;3:24-33. https://doi.org/10.20333/2500136-2018-3-24-33 Ilyin A.S., Teplov P.V., Sakovich V.A. Aorta coarctation as a pathology of cardiovascular system. Our potential in surgery. Sibirskoye Meditsinskoye Obozreniye = Siberian Medical Review. 2018;3(111):24-33. (In Russ.)
  5. https://doi.org/10.20333/2500136-2018-3-24-33
  6. Вахненко Ю.В., Доровских И.Е., Поляков Д.С., Гордиенко Е.Н., Бруева О.Н. Случай первичной диагностики выраженной коарктации аорты у взрослого пациента. Артериальная гипер- тензия. 2021;27(2):229-238. https://doi.org/10.18705/1607-419X-2021-27-2-229-238 Vakhnenko J.V., Dorovskikh I.E., Polyakov D.S., Gordienko E.N., Bruyeva O.N. Case of primary diagnosis of pronounced aortic coarctation in an adult patient. Arterial’naya Gipertenziya =Arterial Hypertension. 2021;27(2):229-238. (In Russ.) https://doi.org/10.18705/1607-419X-2021-27-2-229-238
  7. Vigneswaran T.V., Sinha M.D., Valverde I., Simpson J.M., Charakida M. Hypertension in coarctation of the aorta: challenges in diagnosis in children. Pediatr Cardiol. 2018;39(1):1-10. PMID: 29043396. https://doi.org/10.1007/s00246-017-1739-x
  8. Сойнов И.А., Синельников Ю.С., Горбатых А.В., Ничай Н.Р., Иванцов С.М., Корнилов И.А., Кшановская М.С., Горбатых Ю.Н. Артериальная гипертензия у пациентов после коррекции ко- арктации и гипоплазии дуги аорты. Патология кровообращения и кардиохирургия. 2015;19(2):102-112. https://doi.org/10.21688/1681-3472-2015-2-102-112 Soynov I.A., Sinelnikov Yu.S., Gorbatykh A.V., Nichay N.R., Ivantsov S.M., Kornilov I.A., Kshanovskaya M.S., Gorbatykh Yu.N. Arterial hypertension in patients after correction of coarctation and hypoplasia of the aortic arc. Patologiya krovoobrashcheniya i kardiokhirurgiya = Circulation Pathology and Cardiac Surgery. 2015;19(2):102-112. (In Russ.) https://doi.org/10.21688/1681-3472-2015-2-102-112
  9. Vijayvergiya R., Kasinadhuni G., Batta A., Gawalkar A.A., Singhal M. Percutaneous intervention of coarctation of aorta in an adult man presenting with congestive heart failure. J Invasive Cardiol. 2022;34(12):Е890. PMID: 36476824. https://doi.org/10.25270/jic/22.00100
  10. Alkashkari W., Albugami S., Hijazi Z.M. Management of coarctation of the aorta in adult patients: State of the art. Korean Circ J. 2019;49(4):298-313. PMID: 30895757; PMCID: PMC6428953.
  11. https://doi.org/10.4070/kcj.2018.0433
  12. Аннаниязова С.А., Кадыров Б.А., Сеитмухамедов М.Д., Шихназарова Б.А., Гаипджанов П.П., Аганиязов А.Д. Имплантация стента взрослому пациенту с коарктацией аорты. Вестник
  13. Авиценны. 2023;25(3):424-30. https://doi.org/10.25005/2074-0581-2023-25-3-424-30 Annaniyazova S.A., Kadyrov B.A., Seitmukhamedov M.D., Shikhnazarova B.A., Gaipdzhanov P.P., Aganiyazov A.D. Stent implantation in an adult with coarctation of the aorta: A case report. Vestnik Avitsenny = Avicenna Bulletin. 2023;25(3):424-30. (In Russ.) https://doi.org/10.25005/2074-0581-2023-25-3-424-30
  14. Nana P., Spanos K., Brodis A., Kouvelos G., Rickers C., Kozlik- Feldmann R., Giannoukas A., Kölbel T. A systematic review and meta-analysis on stenting for aortic coarctation management in adults. J Endovasc Ther. 2023;32(3):548-557. PMID: 37287255. https://doi.org/10.1177/15266028231179919
  15. Закирова Э.Б., Курочкин С.В., Ким З.Ф., Лотфуллин А.З., Осипова О.Н., Мунипова Н.В., Зайнуллина Р.Ю. Клинический случай диагностики коарктации аорты в пожилом возрасте. Вестник современной клинической медицины. 2023;16(прил.1):34-41. https://doi.org/10.20969/VSKM.2023.16(suppl.1).34-41 Zakirova E.B., Kurochkin S.V., Kim Z.F., Lotfullin A.Z., Osipova O.N., Munipova N.V., Zainullina R.Yu. A clinical case of detecting aortic coarctation in the elderly. The Bulletin of Contemporary Clinical Medicine. 2023;16(suppl.1):34-41. (in Russ.) https://doi.org/10.20969/VSKM.2023.16(suppl.1).34-41
  16. Nguyen L., Cook S.С. Coarctation of the Aorta: Strategies for Improving Outcomes. Cardiol Clin. 2015;33(4):521-30. PMID: 26471817. https://doi.org/10.1016/j.ccl.2015.07.011
  17. Курочкин С.В., Зидиханов Д.И. Компьютерно-томографическая ангиография в диагностике коарктации аорты. Ком- плексные проблемы сердечно-сосудистых заболеваний. 2017;6(4):169-175. https://doi.org/10.17802/2306-1278-2017-6-4-169-175 Kurochkin S.V., Zidihanov D.I. Computed tomography angiography in the diagnosis of coarctation of the aorta. Complex Issues of Cardiovascular Diseases. 2017;6(4);169-175. (In Russ.) https://doi.org/10.17802/2306-1278-2017-6-4-169-175
  18. Tashiro H., Sato W., Seki K., Ono Y., Kato Tж, Sato T., Watanabe H. Asymptomatic coarctation of the aorta in adults with preserved exercise capacity. Intern Med. 2023;62(8):1171-1174. PMID: 36070945; PMCID: PMC10183278. https://doi.org/10.2169/internalmedicine.0285-22
  19. Рекомендации ESC по ведению взрослых пациентов с врожденными пороками сердца 2020. Российский кардиологиче- ский журнал. 2021;26(9):330-422. https://doi.org/10.15829/1560-4071-2021-4702 ESC recommendations of monitoring of patients with congenital heart defects. Russian cardiology journal. 2020; 26(9): 330-422. (In Russ.) https://doi.org/10.15829/1560-4071-2021-4702
  20. Stout K.K., Daniels C.J., Aboulhosn J.A., Bozkurt B., Broberg C.S., Colman J.M., Crumb S.R., Dearani J.A., Fuller S., Gurvitz M., Khairy P., Landzberg M.J., Saidi A., Valente A.M., Van Hare G.F. 2018 AHA/ ACC guideline for the management of adults with congenital heart disease: a report of the American College of Cardiology/ American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;139:е698-е800. PMID: 30586767. https://doi.org/10.1161/CIR.0000000000000603
  21. Hekim Yılmaz E., Bulut M.O., Küçük M., Yücel İ.K., Erdem A., Çelebi A. Use of covered stents in simultaneous management of coarctation of the aorta and patent ductus arteriosus. Anatol J Cardiol. 2018;19(4):332-336. https://doi.org/10.14744/AnatolJCardiol.2018.61257
  22. Румянцева А.А., Тарасов Р.С., Халивопуло И.К., Шушпанни- ков П.А., Гришачева Е.О. Стентирование критической коарктации аорты у новорожденных: серия клинических случаев. Патология кровообращения и кардиохирургия. 2025;29(1):99-109. https://doi.org/10.21688/1681-3472-2025-1-99-109 Rumyantseva A.A., Tarasov R.S., Khalivopulo I.K., Shushpan- nikov P.A., Grishacheva E.O. Stenting of critical aortic coarctation in newborn: a case series. Patologiya krovoobrashcheniya i kardiokhirurgiya = Circulation Pathology and Cardiac Surgery. 2025;29(1):99-109. (In Russ.) https://doi.org/10.21688/1681-3472-2025-1-99-109
  23. Haji Zeinali A.M., Sadeghian M., Qureshi S.A., Ghazi P. Midterm to long-term safety and efficacy of self-expandable nitinol stent implantation for coarctation of aorta in adults. Catheter Cardiovasc Interv. 2017;90(3):425-431. PMID: 28707350. https://doi. org/10.1002/ccd.27178
  24. Паничкин Ю.В., Дитковский И.А., Черпак Б.В. Эндопротезирование коарктации аорты у подростков и взрослых пациентов. Профилактика и лечение осложнений. Диагностическая и интервенционная радиология. 2014;8(2):52-7. https://doi.org/10.25512/DIR.2014.08.2.06 Panichkin U.V., Ditkovskiy I.A., Cherpak B.V. Stent implantation in treatment of aortic coarctation in teenagers and adults. Prophylactics and treatment complications. Diagnostic & Interventional Radiology. 2014;8(2):52-7. (In Russ.) https://doi.org/10.25512/DIR.2014.08.2.06
  25. Хапченкова Д.С. Этиология и патогенез артериальной гипертензии при коарктации аорты. Российский вестник перина- тологии и педиатрии. 2015;6:27-32 URI:504552494e41542d41525449434c452d323031352d3630 2d362d302d32372d3332 Hapchenkova D.S. Etiology and pathogenesis of hypertension in coarctation of the aorta. Ros Vestn Perinatol Pediat. 2015;6:27-32. (In Russ.) URI:504552494e41542d41525449434c452d323031352d36302d362d302d32372d3332
  26. Murakami T., Takeda A. Enhanced aortic pressure wave reflection in patients after repair of aortic coarctation. Ann Tho rac Surg. 2005;80(3):995-9. PMID: 16122472. https://doi.org/10.1016/j.athoracsur.2005.03.055
  27. Вербовская Н.В., Гринштейн Ю.И. Артериальная гипертония у больных с коарктацией аорты. Особенности функциональ- ной диагностики и клинической картины. Сибирское меди- цинское обозрение. 2008;52(4):64–67. Verbovskaya N.V., Grinshtejn Yu.I. Arterial hypertension at patients with aortic coarctation. Features of functional diag nostics and clinical picture. Sibirskoye Meditsinskoye Obozreniye = Siberian Medical Review. 2008;52(4):64-67. (In Russ.)