Impact of Aortic Geometry on Vascular Remodeling After Stent Implantation in Coarctation of the Aorta

Impact of Aortic Geometry on Vascular Remodeling After Stent Implantation in Coarctation of the Aorta

This study aims to assess:

1. Aortic geometrical changes and their relationship to hypertension and cardiovascular events.
2. Aortic geometrical differences between healthy individuals and patients with repaired coarctation of the aorta.

Coarctation of the aorta (CoA) is a congenital narrowing of the aortic lumen, accounting for 5-8% of congenital heart diseases, with an incidence of 1 in 3000-4000 live births . This narrowing leads to altered hemodynamics, including increased left ventricular afterload, systemic hypertension, and long-term vascular remodeling, which can persist even after anatomical correction .

Despite advances in interventions like stent implantation for native or recurrent CoA, many patients remain hypertensive post-procedure . This residual hypertension may not be purely mechanical but linked to persistent vascular dysfunction, abnormal aortic compliance, or inadequate aortic wall remodeling .

Aortic stiffness is now recognized as a key cardiovascular risk factor in CoA patients . Reduced elasticity contributes to high systolic blood pressure, increased cardiac workload, and late cardiovascular complications [7]. Moreover, abnormal aortic arch geometry-particularly the "gothic arch"-has been linked to impaired vascular function and unfavorable hemodynamics [13].

While cardiac magnetic resonance (CMR) is the standard for evaluating aortic stiffness and ventricular function , CT Aortography offers high-resolution images to assess aortic distensibility, luminal changes, and residual stenosis, especially post-stenting . When combined with blood pressure and ECG data, these insights can provide a fuller picture of outcomes .

This study investigates the relationship between post-stenting blood pressure and aortic geometry-including arch shape and residual stenosis-using CT Aortography in CoA patients. It also explores ECG changes as potential non-invasive markers of ventricular strain and hemodynamic stress ..

Inclusion Criteria:

Age ≥ 12 years.

Diagnosed with native or recurrent coarctation of the aorta.

Transcatheter systolic pressure gradient ≥ 20 mmHg.

Body weight ≥ 20 kg.

Availability of pre- and post-stenting CT aortography data.

Exclusion Criteria:

Patients with obstructive lesion of LVOT or aortic valve dysfunction greater than moderate (requiring surgical intervention)..

Patients with other causes of secondary hypertension.

Associated complex congenital heart defects (aside from simple septal defects and patent ductus arteriosus)

Genetic syndromes

Connective tissue disorder

History of surgery involving the aortic root or ascending aorta.

Incomplete imaging or missing data relevant to the study.