Covered CP Stents for the Prevention or Treatment of Aortic Wall Injury Associated With Coarctation of the Aorta

There are no prior trials of preventing or treating aortic injury associated with CoA and thus no basis for comparison. A single outcome assessment will not suffice since patients can receive a device for either indication. A 3-category Severity of Illness Scale (SIS) was developed based on clinical judgment of a panel of pediatric cardiologists and reviewed by a Data & Safety Monitoring Board (DSMB) and the FDA Office of Device Evaluation. Five levels of severity have been defined for each of the 3 illness categories, including: Upper extremity hypertension, Upper to lower extremity pressure difference, and Severity of aortic wall injury. The DSMB will assign a level of illness from the SIS for each patient at baseline and one year follow up. Improvement by at least one level will indicate clinical importance. Safety is evaluated by identifying adverse events and comparing their occurrence to surgical repair of CoA in similar age groups reported in the medical literature.

Inclusion criteria

Inclusion criteria for use of a Covered CP Stent:

Native or recurrent aortic coarctation* associated with ONE OR MORE of the following:

• Acute or chronic aortic wall injury, or
• Nearly atretic descending aorta to 3 mm or less in diameter, or
• Genetic Syndromes associated with aortic wall weakening. Individuals with genetic syndromes such as Marfan Syndrome, Turner's Syndrome or familial bicuspid aortic valve and ascending aortic aneurysm

• The significance of aortic obstruction is left to the judgment of the participating investigator.

indications might include mild resting aortic obstruction associated with:

• Exercise related upper extremity hypertension;
• Severe coarctation with multiple and/or large arterial collaterals;
• Single ventricle physiology
• Left ventricular dysfunction
• Ascending aortic aneurysm

+ Aortic wall injury might include:

• Descending aortic aneurysm
• Descending aortic pseudo-aneurysm
• Contained aortic wall rupture
• Non-contained rupture of the aortic wall

Exclusion criteria

• Patient size too small for safe delivery of the device. The absolute lower limit for inclusion under this protocol is 20 kg. However, serious femoral artery injury can occur in small patients, particularly those in the 20-30 kg range and this risk must be reviewed in detail with parents or guardians of children in this weight range.
• Planned deployment diameter less than 10 mm or greater than 22 mm
• Location requiring covered stent placement across a carotid artery*
• Adults lacking capacity to consent
• Pregnancy

• crossing or covering of a subclavian artery is acceptable in certain situations, but only after alternative treatments have been considered.