CLINICAL STUDY: PEDIATRIC CARDIOLOGY
Redilation of endovascular stents in congenital heart disease: factors implicated in the development of restenosis and neointimal proliferation
Colin J. McMahon, MB, BAO, BCh, MRCP*,
Howaida G. El-Said, MD, PhD*,
Ronald G. Grifka, MD, FACC*,
J. Kennard Fraley, MPH ,
Michael R. Nihill, MD, FACC* and
Charles E. Mullins, MD, FACC*
* LillieFrank Abercrombie Division of Pediatric Cardiology, Texas Children’s Hospital and Baylor College of Medicine, Houston, USA
Children’s Nutrition Research Center, Houston, Texas, USA
Manuscript received January 10, 2001;
revised manuscript received April 19, 2001,
accepted April 27, 2001.
Reprint requests and correspondence: Dr. Howaida G. El-Said, Division of Pediatric Cardiology, Texas Children’s Hospital, 6621 Fannin, MC 2-2280, Houston, Texas 77030
hgelsaid{at}texaschildrenshospital.org
OBJECTIVES
We sought to determine the incidence of and risk factors for the development of restenosis and neointimal proliferation after endovascular stent implantation for congenital heart disease (CHD).
BACKGROUND
Risk factors for the development of restenosis and neointimal proliferation are poorly understood.
METHODS
This was a retrospective review of patients who underwent endovascular stent redilation between September 1989 and February 2000.
RESULTS
Of 368 patients who had 752 stents implanted, 220 were recatheterized. Of those 220 patients, 103 underwent stent redilation. Patients were classified into three groups: 1) those with pulmonary artery stenosis (n = 94), tetralogy of Fallot/pulmonary atresia (n = 72), congenital branch pulmonary stenosis (n = 9), status post-Fontan operation (n = 6), status post-arterial switch operation (n = 7); 2) those with iliofemoral venous obstruction (n = 6); and 3) those with miscellaneous disorders (n = 3). The patients’ median age was 9.9 years (range 0.5 to 39.8); their mean follow-up duration was 3.8 years (range 0.1 to 10). Indications for stent redilation included somatic growth (n = 67), serial dilation (n = 27) and development of neointimal proliferation or restenosis, or both (n = 9). There was a low incidence of neointimal proliferation (1.8%) and restenosis (2%). There were no deaths. Complications included pulmonary edema (n = 1), hemoptysis (n = 1) and contralateral stent compression (n = 2).
CONCLUSIONS
Redilation or further dilation of endovascular stents for CHD is effective as late as 10 years. The risk of neointimal proliferation (1.8%) and restenosis (2%) is low and possibly avoidable. Awareness of specific risk factors and modification of the stent implantation technique, including avoidance of minimal stent overlap and sharp angulation of the stent to the vessel wall and avoidance of overdilation, have helped to reduce the incidence of restenosis.
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Abbreviations and Acronyms
| | ASO | = arterial switch operation | | CBPS | = congenital branch pulmonary stenosis | | CHD | = congenital heart disease | | FA | = femoral artery | | IVC | = inferior vena cava | | PA | = pulmonary atresia | | RV | = right ventricle or ventricular | | SVC | = superior vena cava | | TOF | = tetralogy of Fallot | | TR | = tricuspid regurgitation |
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