SPC365

TEVAR plus balloon expandable stent: a novel hybrid endovascular approach for complex coarctation of aorta repair.

Session: SESSÃO DE POSTERS 04 - AMILOIDOSE E AORTA
Speaker: Francisco Barbas De Albuquerque

Congress: CPC 2025
Topic: K. Cardiovascular Disease In Special Populations
Theme: 30. Cardiovascular Disease in Special Populations
Subtheme: 30.3 Cardiovascular Disease in Special Populations: Pediatric Cardiology
Session Type: Cartazes
FP Number: ---
Authors: Francisco Barbas De Albuquerque; Lídia de Sousa; Petra Loureiro; Gonçalo Alves; José Diogo Ferreira Martins

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:10.0pt">Background</span></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:10.0pt">Coarctation of the aorta (CoA) is a common congenital heart defect, typically treated with balloon-expandable stents. In rare cases, it can lead to complex aortic aneurysms and dissections, presenting challenges for balloon expandable stents. While surgery has been the primary treatment for such cases, advancements in interventional cardiology offer minimally invasive options. A hybrid approach combining thoracic endovascular aortic repair (TEVAR) with conventional balloon expandable stents may serve as a viable alternative for such cases. </span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:10.0pt">Aim</span></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:10.0pt">To describe two clinical cases of complex CoA where a hybrid endovascular approach using simultaneous TEVAR and balloon-expandable stents was performed.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:10.0pt">Methods</span></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:10.0pt">A single-center descriptive study of two consecutive patients that performed a hybrid endovascular repair of complex CoA.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:10.0pt">Results</span></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:10.0pt">Patient 1</span></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:10.0pt">A 36-year-old male presented with severe uncontrolled hypertension. During investigation, transthoracic echocardiographic (TTE) revealed a gradient of 89 mmHg in the descending aorta. Cardiac-CT scan confirmed a critical CoA (5.2x5 mm least diameter) 40 mm after left subclavian artery origin. A calcified aortic aneurysm (43x36 mm) after CoAo was observed (figure 1A). After Heart Team discussion, the patient was accepted for percutaneous intervention.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:10.0pt">An endovascular hybrid approach was conducted, with a Zenith Alpha Thoracic Endovascular Graft Alpha 39x15 mm implantation for aneurysm exclusion followed by a stent BeGraft &nbsp;37x22 mm for CoAo correction. The final angiography showed no stenosis, endoleaks (figure 1B) or residual gradient.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:10.0pt">Patient 2</span></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:10.0pt">An 18-year-old female with a past medical history of CoA of percutaneous angioplasty in an outside institution was referred to our center with reCoA and a suspected aneurysm. Angiography revealed an aneurysm between the left subclavian artery and the aortic isthmus (17 mm of max diameter and 24 mm of length), a long-segment (32 mm) CoA and multiple dissected sites between the left subclavian artery and aortic isthmus (figure 1C). After Heart Team discussion, the patient was admitted to percutaneous intervention.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:10.0pt">An endovascular hybrid approach was conducted. First, a TEVAR Zenith 24x24x10 was implanted, followed by a BeGraft 16x18 mm stent in the long-segment stenosis. The final angiography showed no stenosis, endoleaks (figure 1D), or residual gradient.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:10.0pt">Conclusion</span></strong></span></span></p>

<p><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:10.0pt">We present two complex cases of CoAo where a hybrid endovascular approach was successfully conducted. This technique adds the benefit of self-expanding stents which exclude the aneurysm and high-radial strength balloon expandable stents which treat the stenosis. No complications were reported. These cases highlight a novel, minimally invasive technique to be implemented in these challenging clinical scenarios.</span></span></span></p>