From balloon angioplasty to covered stents in the management of coarctation of the aorta in adults with congenital heart disease

Coarctation of the aorta (CoA) occurs in 0.04% of the population and accounts for approximately 10% of lesions in adults with congenital heart disease (ACHD). It can occur as an isolated lesion or as a part of a complex defect and is associated with multiple complications, both with and without treatment. Since the first surgical repair in 1944, significant refinement in surgical techniques has expanded the available treatment options. While transcatheter therapy for both native and especially recurrent CoA has become the standard of care for young patients, the use of bare metal stent has been associated with significant complications in adults. Perhaps one of the most important advances in the management of CoA, has been the development of covered stent technology. Covered stents offer the advantage of excluding any stretch-induced wall trauma from the endoluminal aspect of the aorta, particularly in the catastrophic event of aortic rupture which has been reported. Here we describe the indications for and the limitations in the use of covered stents in the treatment of CoA. These may be used as the therapy of choice in patients with native CoA, complications after prior CoA repair, patients with severe and complex CoA lesions, or patients with advanced age.