Intentional Stent Fracture to Accommodate Growth After Coarctation Stenting in an 860-g Neonate

Sep 30, 2026

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Background: Congenital aortic coarctation in neonates and children may be treated with transcatheter stent implantation, yet the fixed stent architecture must be accommodated as the vessel grows. Case summary: A premature 860-g infant with critical coarctation received a coronary stent at 1 week, followed by serial dilatations; at 3 months a second stent was added, and after 1 year an ultra-high-pressure balloon induced an intentional fracture. Discussion: Intentional stent fracture with ultrahigh-pressure ballooning can reduce complex reinterventions, while pre-stenting may prevent complications such as fracture-related issues.

LanguageEnglish

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Abstract

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Case Summary

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Case Report

Catheterization and Cardiovascular Interventions CASE REPORT Intentional Stent Fracture to Accommodate Growth After Coarctation Stenting in an 860‐g Neonate Magdalena Cuman1 | Gernot Buheitel2 | Peter Ewert1 | Stanimir Georgiev1 1Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich, Lazarettstraße, Munich, Germany | 2Department of Pediatric Cardiology and Congenital Heart Disease, University Hospital Augsburg, Stenglinstraße, Augsburg, Germany Correspondence: Magdalena Cuman ([magdalena.cuman@gmail.com](magdalena.cuman@gmail.com)) Received: 26 March 2025 | Revised: 16 October 2025 | Accepted: 23 October 2025 Keywords: napkin‐ring configuration | neonatal aortic coarctation | stent cracking/intentional stent fracture ABSTRACT Background: Congenital aortic coarctation in neonates and children can be managed with transcatheter stent implantation, but this approach raises the issue of how to accommodate the fixed stent structure within the growing vessel. Case Summary: A 15‐month‐old boy, born prematurely with critical aortic coarctation, was treated at 1 week of age with the implantation of a coronary stent. Subsequently, multiple stent dilatations were needed to adapt it to the growing aortic vessel. At 3 months the patient underwent balloon dilation with the simultaneous implantation of a second stent, and after 1 year an ultra‐high‐pressure balloon dilatation with intentional fracture of the coronary stent was performed. Discussion: To overcome the problem of stenting a growing vessel, intentional stent fracture (ISF) with ultrahigh‐pressure (UHP) balloon has been introduced and applied in a limited number of patients. In piglet models, the ISF technique was associated with a significant incidence of complications, which were preventable (with the exception of stent fragment embolization) by performing pre‐stenting before ISF. 1 | Introduction Stent implantation is now considered the first‐line therapy for aortic coarctation (CoA) in adults [1–3] . The advantages of this method have led to its use in adolescents and children [4] and, in some centers, even in small infants [5]. One of the limitations of stent use in growing patients is that they require periodic redilation to accommodate the child's somatic growth. Transcatheter intentional stent fracture (ISF) along the longitudinal axis of an undersized stent using ultra‐high‐pressure (UHP) balloons could potentially obviate the need for challenging surgical stent manipulations [6, 7] . Bench testing and in vivo animal studies have shown that overdilation of a stent alters the shape of its individual cells, changing them from a roughly hexagonal shape to a slit‐like rectangular shape, with the circumferential stent struts aligning to form parallel “rings” and potentially creating a napkin‐ring that puts the balloon at risk of rupture and may eventually require surgical intervention as the only means to remove the metallic ring. To prevent this and other complications (i.e. stent collapse, hemodynamic compromise and embolization of stent fragments) the implantation of a second stent into the previously stented area before ISF has been successfully demonstrated in a piglet model [8] . Our group also performed extensive bench‐side testing and a small initial series of children using a standardized ISF approach was recently published [9] . 2 | Case Report We present the case of a premature twin boy, born at 28 + 1 weeks of gestation through an elective cesarean section in a tertiary perinatal center. At 10 days of life, a significant arm‐to‐leg differential pressure was documented, and echocardiographic examination revealed severe aortic isthmus stenosis. Prostaglandin This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. © 2025 The Author(s) . Catheterizatio

FAQs

Why is growth accommodation a concern after neonatal coarctation stenting?

Neonatal aortic coarctation treated with a transcatheter stent introduces a challenge because the stent remains fixed while the vessel continues to grow, requiring subsequent adaptation.

What staged interventions were performed in the reported infant?

The patient received coronary stent implantation at 1 week, underwent multiple stent dilatations, had balloon dilation with simultaneous implantation of a second stent at 3 months, and received ultra-high-pressure balloon dilatation with intentional fracture after 1 year.

How does intentional stent fracture aim to reduce future reinterventions?

Intentional stent fracture along the longitudinal axis using an ultrahigh-pressure balloon is introduced to potentially avoid repeated challenging surgical stent manipulations, while bench and animal data guide prevention of complications.

Sep 30, 2026

Uploaded by Ezra