Transcatheter Endovascular Management of Complex Coarctation of the Aorta in Adults (JACC Case Reports June 2025)-Article: Transcatheter Endovascular Management of Complex Coarctation of the Aorta in Adults

Article: Transcatheter Endovascular Management of Complex Coarctation of the Aorta in Adults

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The document details the clinical management of complex coarctation of the aorta (CoA) in adults using transcatheter endovascular approaches, presenting two successful case studies. CoA is a narrowing of the aorta often diagnosed in adults during hypertension work-ups. Traditional surgical options have evolved with advances in endovascular techniques, including balloon dilatation and the use of covered and uncovered stents.<br /><br />The first case involved a 44-year-old man with long-segment CoA, hypertension resistant to five medications, and severe aortic regurgitation. A custom-made 120-mm Cheatham platinum stent was deployed, resulting in a zero systolic gradient post-procedure and significant improvement in cardiac function and blood pressure control.<br /><br />The second case featured a 38-year-old man with hypertension and aortic coarctation with associated aneurysms and hypoplastic arch. This case required a complex, meticulously planned intervention using both covered and uncovered stents to address potential aneurysm risks and preserve subclavian artery perfusion. The procedure also resulted in successful exclusion of aneurysms and normalized blood pressure without medications post-treatment.<br /><br />Both cases underscore the effectiveness of transcatheter interventions as a preferred treatment strategy for complex CoA in adults, highlighting the importance of thorough pre-procedural planning and imaging, such as CT aortography and advanced imaging modalities, to guide patient-specific treatment plans. The document also discusses the historical progression of CoA treatment, from early surgical interventions to advanced stent technologies that minimize risks associated with traditional surgery, like aneurysm formation and prolonged recovery. This case series is part of ongoing efforts to refine endovascular strategies for complex aortic pathologies, emphasizing safe, feasible, and effective management without the complications of open surgical repair.

Keywords

complex coarctation of the aorta

transcatheter endovascular approaches

case studies

balloon dilatation

covered stents

uncovered stents

Cheatham platinum stent

pre-procedural planning

CT aortography

endovascular strategies