Surgical treatment of pediatric acute traumatic aortic injury (TAI) after blunt chest
trauma is standard of care. Use of endovascular
stent grafts for treatment of TAI in adults is common but has important limitations in children. We sought to describe the use of balloon-expandable covered endovascular
stents for treatment of TAI in children and adolescents. Participants of the multicenter
Coarctation of the Aorta Stent Trial (COAST) had access to investigational large-diameter, balloon-expandable, covered
stents (covered Cheatham-
platinum stents; NuMed, Inc., Hopkinton, New York) on an emergency-use basis. From 2008 through 2011, 6 covered
stents were implanted in 4 patients at 3 COAST centers for treatment of TAI. Median patient age was 13.5 years (range 11 to 14) and weight was 58 kg (40 to 130). All patients sustained severe extracardiac
injuries that were judged to preclude safe open surgical repair of TAI. Median aortic isthmus and
stent implantation balloon diameters were 16.4 mm (13.2 to 19) and 19 mm (16 to 20), respectively.
Stent implantation was technically successful in all attempts. Complete exclusion of aortic wall injury was achieved in all cases. There were no access site complications. At a median follow-up of 24 months, there was 1 early death (related to underlying
head trauma) and 1 patient with recurrent
aortic aneurysm who required additional
stent implantation. In conclusion, balloon-expandable covered-
stent implantation for treatment of pediatric TAI after blunt
trauma is generally safe and effective. Availability of this equipment may alter the standard approach to treatment of pediatric TAI.