Author + information
- Received April 28, 2013
- Accepted May 9, 2013
- Published online February 1, 2014.
- Dobrin Iotkov Vassilev, MD, PhD∗,
- Gianluca Rigatelli, MD, PhD†∗ (, )
- Ana Kaneva-Nencheva, MD, PhD∗,
- Elisaveta Levunlieva, MD∗ and
- Alexander Alexandrov, MD∗
- ∗National Heart Hospital, Sofia, Bulgaria
- †Adult Congenital Heart Interventions, Rovigo General Hospital, Rovigo, Italy
- ↵∗Reprint requests and correspondence:
Dr. Gianluca Rigatelli, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Viale Tre Martiri, 45100 Rovigo, Italy.
A 16-year-old boy with severe coarctation of the aorta with hypoplastic arch and subvalvular aortic stenosis had been operated on at 2 and 7 years of age for coarctation repair and subaortic stenosis relief. Recoarctation developed at 10 years of age, and he underwent aortic stenting with a CP Stent (NuMED Inc., Hopkinton, New York) with complete abolition of the transaortic gradient. After 5 years, recoarctation developed due to proliferative intimal hyperplasia within the previously implanted stent causing a mean gradient of 40 mm Hg (Fig. 1A). Because of the proximity of the left carotid artery to the recoarctation site and the amount of intimal hyperplasia, a 5-mm SpiderFX neuroprotection filter (Boston Scientific, Plymouth, Minnesota) was placed in the left internal carotid artery over a standard 0.014-inch guidewire. Access was obtained via a right radial artery approach, catheterizing the left common carotid artery with a 5-F mammary diagnostic catheter and advancing a 100-cm 6-F sheath (Fortress Biotronik, Berlin, Germany) over a 0.35-inch Amplatz Super Stiff guidewire (Boston Scientific) into the external left carotid artery (Fig. 1B). Redilation of the restenotic stent was accomplished with an XXL 14 × 40-mm balloon (Boston Scientific) with reduction of the gradient to 8 mm Hg (Fig. 1C). After removing the filter wire, inspection of the device revealed the presence of debris in the filter basket (Fig. 1D).
Although previously unreported, cerebral protection of the left carotid artery during treatment of in-stent restenosis at the coarctation site may be important in children and young adults to avoid debris embolization from in-stent intimal hyperplasia, especially when present in a large amount. Moreover, using a radial artery access for cerebral filter placement, as recently suggested for carotid artery stenting (1), can minimize both the manipulation of the aortic arch and the invasiveness of the procedure. By using a right radial approach, any interference with the recoarctation angioplasty procedure can be easily avoided.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 28, 2013.
- Accepted May 9, 2013.
- 2014 American College of Cardiology Foundation