Endovascular stenting for coarctation of the aorta in Infants and young children in southeast Iran: A retrospective study

Document Type : Original Article

Authors

1 Clinical Research Development Unit, Shahid Bahonar Hospital, Kerman University of Medical Sciences, Kerman, Iran

2 Department of Pediatrics, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran

10.48305/arya.2026.45312.3062
Abstract
BACKGROUND: Coarctation of the aorta (CoA) in infants and young children is typically treated with high-risk open-heart surgery. Endovascular stenting provides a less invasive alternative; however, its safety and efficacy remain underexplored. This study aimed to evaluate procedural success, complications, and four-year outcomes of stenting for CoA.
METHODS: A retrospective review included 30 infants and young children (28 days to 3 years of age, weight >2.5 kg) with CoA who underwent endovascular stenting in Kerman and Sistan-Baluchestan, Iran, from 2024 to 2025. Patients with complex heart defects requiring immediate surgery or weighing <2.5 kg were excluded. Diagnostics utilized echocardiography, femoral angiography (for gradient assessment), and CT angiography. Outcomes included reduction in gradient, minor complications (hematoma, transient arrhythmia, localized bleeding, and bruising), major complications (stent thrombosis, vascular rupture, stent migration, vascular injury, sepsis, and mortality), and stent patency.
RESULTS: Procedural success was achieved in 27 out of 30 patients (90%, 95% CI: 73.5–97.9%). The mean gradient was reduced by 89% (from 45 ± 10 mmHg to 5 ± 3 mmHg, p<0.001). Minor complications occurred in 3 of 30 patients (10%; 95% CI: 2.1–26.5%), including 2 hematomas and 1 transient arrhythmia; no major complications or mortality were reported. Four-year stent patency was 90% (95% CI: 73.5–97.9%); 3 out of 30 patients (10%) required re-dilation at 2.5 years due to growth. Cox regression analysis found no predictors for re-intervention (p>0.05).
CONCLUSION: Endovascular stenting seems to be a safe and effective alternative for CoA in infants and young children. Larger prospective studies are necessary.

Keywords


1. Parker DM, Stabler ME, MacKenzie TA, Zimmerman MS, Shi X, Everett AD, et al. Population-Based Estimates of the Prevalence of Children With Congenital Heart Disease and Associated Comorbidities in the United States. Circ Cardiovasc Qual Outcomes. 2024 Sep;17(9):e010657. https://doi.org/10.1161/circoutcomes.123.010657
2. Nezami A, Heidari G, Tarhani F, Kariminia M. Prevalence of Congenital Heart Disease among Children in Khorramabad (West of Iran). Cardiovasc Hematol Disord Drug Targets. 2021;21(1):61-65. https://doi.org/10.2174/1871529x20999201231205746
3. Amini-Rarani M, Karimi SE, SoleimanvandiAzar N, Nosratabadi M. Risk and protective factors related to having a child with congenital heart diseases (CHD): a case-control study in Iran. Front Pediatr. 2023 Jul 3;11:1170743. https://doi.org/10.3389/fped.2023.1170743
4. Dijkema EJ, Leiner T, Grotenhuis HB. Diagnosis, imaging and clinical management of aortic coarctation. Heart. 2017 Aug;103(15):1148-55. https://doi.org/10.1136/heartjnl-2017-311173
5. Chetan D, Mertens LL. Challenges in diagnosis and management of coarctation of the aorta. Curr Opin Cardiol. 2022 Jan 1;37(1):115-22. https://doi.org/10.1097/hco.0000000000000934
6. Torok RD, Campbell MJ, Fleming GA, Hill KD. Coarctation of the aorta: Management from infancy to adulthood. World J Cardiol. 2015 Nov 26;7(11):765-75. https://doi.org/10.4330/wjc.v7.i11.765
7. Rao PS. Congenital heart defects: a review. In: Rao PS, editor. Congenital Heart Disease: Selected Aspects. Rijeka (Croatia): InTech; 2012. p. 3-44.
8. Ahmadi A, Mansourian M, Sabri MR, Ghaderian M, Karimi R, et al. Follow-up outcomes and effectiveness of stent implantation for aortic coarctation: A systematic review and meta-analysis. Curr Probl Cardiol. 2024 Jun;49(6):102513. https://doi.org/10.1016/j.cpcardiol.2024.102513
9. Ghaderian M, Sabri MR, Ahmadi A, Bayat S. Our first experience in stenting of coarctation of aorta in infants and small children; A case series study. ARYA Atheroscler. 2019 Mar;15(2):93-8. https://doi.org/10.22122/arya.v15i2.1961
10. Rao PS. Coarctation of the aorta. In: Rao PS, Vidyasagar D, editors. Perinatal Cardiology: A Multidisciplinary Approach. Minneapolis (MN): Cardiotext Publishing; 2015. Chapter 38.
11. Allen HD, Shaddy RE, Penny DJ, Feltes TF, Cetta F, editors. Moss and Adams’ Heart Disease in Infants, Children, and Adolescents: Including the Fetus and Young Adults. 10th ed. Philadelphia: Wolters Kluwer; 2021.
12. Kang SL, Tometzki A, Taliotis D, Martin R. Stent Therapy for Aortic Coarctation in Children <30 kg: Use of the Low Profile Valeo Stent. Pediatr Cardiol. 2017 Oct;38(7):1441-49. https://doi.org/10.1007/s00246-017-1682-x