Published Online
on December 15, 2008

A more recent version of this article appeared on February 1, 2009

This Article Full Text (PDF) All Versions of this Article: 2/1/52    most recent CIRCINTERVENTIONS.108.826263v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Maglione, J. Articles by McElhinney, D. B. Search for Related Content PubMed Articles by Maglione, J. Articles by McElhinney, D. B. Related Collections Other Treatment Pediatric and congenital heart disease, including cardiovascular surgery Related Article

Original Article

Ultra-High-Pressure Balloon Angioplasty for Treatment of Resistant Stenoses Within or Adjacent to Previously Implanted Pulmonary Arterial Stents

Jessica Maglione; Lisa Bergersen; James E. Lock and Doff B. McElhinney¹

Children's Hospital Boston and Harvard Medical School, Boston, MA

¹ E-mail: doff.mcelhinney{at}cardio.chboston.org

Background—Stents are essential tools in the management of pulmonary arterial (PA) stenosis in patients with congenital heart disease. Although stents can usually be reexpanded as children grow, resistant in-stent or peri-stent obstruction can complicate the management of PA stents. Angioplasty with ultra-high-pressure (UHP) balloons may facilitate successful treatment of stent-associated PA stenoses that are resistant to high-pressure dilation.

Methods and Results—We reviewed patients who underwent UHP angioplasty of in-stent or peri-stent PA stenoses that were resistant to high-pressure redilation. A resistant stenosis was defined as a residual balloon waist during high-pressure redilation of the stent, along with a pressure gradient and/or angiographic stenosis. Thirty-four lesions in 29 patients, including 8 with multiple concentric, overlapping, or adjacent stents, were included. The median age at UHP angioplasty was 9 years, and a median of 4 years had elapsed since unsuccessful high-pressure angioplasty. Thirty-one of the 34 (91% [81-100%]) UHP angioplasty procedures were successful in relieving the resistant stenosis. Balloon:waist diameter ratios were conservative (median 1.26), reflecting the ability of UHP balloons to "fracture" nearly all obstructions. After UHP dilation, lesion diameter increased by a median of 3.1mm (36%), significantly more than after prior high-pressure dilation (1.3mm, 19%; p<0.001). In 5 lesions, UHP angioplasty fractured the stent, allowing further vessel expansion. There were no vascular or other complications.

Conclusions—UHP angioplasty was safe and effective for treatment of stent-related resistant PA stenosis in this series; the ability to fracture maximally expanded stents may extend the utility of stents in the pediatric population.

Key Words: angioplasty • balloon • heart defects, congenital • pediatrics • stents

Related Article

Ultra-High-Pressure Balloon Angioplasty for Treatment of Resistant Stenoses Within or Adjacent to Previously Implanted Pulmonary Arterial Stents

Jessica Maglione, Lisa Bergersen, James E. Lock, and Doff B. McElhinney
Circ Cardiovasc Interv 2009 2: 52-58. [Abstract] [Full Text] [PDF]