Endovascular treatment of middle aortic syndrome in young patients

Middle aortic syndrome (MAS) is a variety of aortic coarctation (CoA) characterized by aortic narrowing with visceral and renal arteries involvement: it concerns both pediatric age and young adults. Many causes have been prospected but exact etiology is still unknown. Lower limb claudication and severe hypertension are often presents. Surgical treatment is the gold standard but endovascular approach is still performed. Between May 2006 and May 2007, three patients (2 males and 1 female), aged between 16-22 years (mean age 19.6 years), were referred to our Institute for severe hypertension refractory to pharmacological therapy under suspicion of CoA. All patients underwent preoperative computed tomography (CT) scan with contrast medium confirming aortic narrowing. The aorta involved was the distal thoracic, in one case, and the abdominal aorta in the other cases. All patients underwent Cheatham-platinum stent implantation (CP-stent™, NuMED Inc., Hopkinton, NY, USA). No immediate complications were observed. All patients were discharged in the II postoperative day in good clinical conditions. On discharge, no patient showed basal hypertension and at 18-month follow-up no ultrasound signs of restenosis or recoil were presents with good blood pressure control in all cases. This article reports three cases of MAS treated by stent implantation. Even if surgical approach still remains the gold standard, endovascular treatment could be performed. CP stent™ implantation is safe and feasible to treat MAS in young patients. Further investigations are mandatory, due to the lack of data about very long-term follow-up, but our preliminary results are still encouraging.