A covered stent used in aortic coarctation migrates proximally during deployment causing transverse arch obstruction:...

Stent angioplasty with covered stents to avoid risk of aortic injury is the preferred mode of management of coarctation of aorta in adults and older children. Severe isthmic coarctation in an adult male with uncontrolled systemic hypertension was managed at another institution using a covered stent. A proximal stent migration during deployment resulted in obstruction of transverse aortic arch and left subclavian artery and was recognized one month after the procedure. This resulted in significant aortic gradients and left arm hypoperfusion. It was managed successfully by use of snares and additional overlapping stents, the first of this type in literature. Awareness of factors leading to stent migration and techniques involved in repositioning these stents may help cardiologists who deal with these interventions. <Learning objective: Distal stent migration is a known complication of coarctation stenting, often managed by expanding the stent in descending thoracic aorta where there are no major branches. However, proximal migration of covered stent leads to aortic arch obstruction including occlusion of arch branches. Techniques of delayed percutaneous repositioning of covered stent are described in this report.>.