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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

View larger version (95K): [in a new window]   Figure 1 Angiograms of the pulmonary arteries, delineating a lack of sufficient stent overlap. a) Two stents in the right pulmonary artery nearly became separated. b) Intimal build-up noted at the site of insufficient overlap and not in the remainder of the stents.

View larger version (100K): [in a new window]   Figure 2 Angiograms of the right pulmonary artery, delineating sharp angulation (right anterior oblique and cranial projections). a) Initial curvature of the vessel before stenting. b) Stenosis at recatheterization after the initial stent implant. c) Restenting with several shorter overlapping stents.

View larger version (111K): [in a new window]   Figure 3 Angiograms of the pulmonary arteries, delineating overdilation of the right pulmonary artery at the initial stent implant. a) Stretched/elongated right and left pulmonary arteries before stent placement. b) Neointimal proliferation of the left pulmonary artery at the time of recatheterization. c) Angiogram of the left pulmonary artery after redilation.

View larger version (100K): [in a new window]   Figure 4 Anteroposterior projection of the pulmonary arteries, delineating abnormal tissue characteristics. a) The branch pulmonary arteries after the initial balloon dilation appear stretched and elongated. b) The proximal vessel is "contracted down" after placement of the distal stent. c) The proximal stent is placed in the same setting.

View larger version (96K): [in a new window]   Figure 5 Lateral projection of the same pulmonary arteries as in Figure 4. a) Again, the branch pulmonary arteries after the initial balloon dilation appear stretched and elongated. b) The proximal vessel is "contracted down" after placement of the distal stent. c) The proximal stent is placed in the same setting.