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Coarctation of the Aorta: An Atypical Case Treated by a Double Layer Stent Technique
Jose Damian Herrera Mingorance1, Ana María Pérez Bailón2, Jose Maria Moreno Escobar1
1Hospital Universitario Clínico San Cecilio, Granada, Spain.
Insights
Coarctation of the aorta (CoA) can present atypically in adults. A novel double layer stent technique successfully treated a complex CoA case, improving patient hemodynamics and preventing cardiogenic shock.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Case Reports
Background:
- Coarctation of the aorta (CoA) is a congenital heart defect often presenting as adult hypertension.
- Endovascular repair with stent placement is the preferred treatment for adult CoA when feasible.
Observation:
- A 41-year-old woman presented with sudden dyspnea and hemodynamic instability due to a complex, calcified aortic coarctation.
- The patient rapidly deteriorated into cardiogenic shock with multiple organ failure, necessitating urgent intervention.
Findings:
- A double layer stent technique was employed, involving coaxial deployment of a BeGraft aortic stent followed by a GORE® TAG® thoracic stent graft.
- This approach resulted in significant clinical improvement, with a reduced radial-femoral systolic pressure gradient from 53 mmHg to 12 mmHg.
Implications:
- Sudden onset CoA in adults is a rare but critical condition.
- The double layer stent technique offers high radial force and improved wall apposition, potentially reducing stent collapse in complex anatomical cases.
Introduction:
Coarctation of the aorta (CoA) is one of the more common congenital heart defects that usually manifests in adults as poorly controlled hypertension. When technically possible, the treatment of choice for adult CoA is an endovascular approach with covered stent placement. A case is presented with atypical clinical onset, treated endovascularly with a double layer stent technique.
Report:
A 41 year old previously asymptomatic woman with an unremarkable past medical history presented with sudden dyspnoea, unstable blood pressure and pulse, and a radial femoral systolic pressure difference of 53 mmHg. A computed tomography scan showed coral reef aorta: aortic stenosis from a highly calcified lesion located distal to the origin of the left subclavian artery, compatible with CoA. Within a few hours, the patient went rapidly into cardiogenic shock with multiple organ failure requiring urgent intervention. Using a dual left iliac conduit and right brachial artery access, the lesion was pre-dilated with an 8 × 60 mm balloon. A double layer technique was then applied by coaxially deploying a BeGraft aortic stent (expanded to 18 mm) followed by a Conformable GORE® TAG® thoracic stent graft (26 × 26 × 100 mm). The patient's symptoms improved and the radial femoral systolic gradient decreased to 12 mmHg.
Discussion:
Sudden onset CoA is a rare condition in adults that can lead to refractory cardiogenic shock and multiple organ failure. In anatomically complex cases, a double layer technique may be beneficial because it has high radial force and good wall apposition with lower risk of stent collapse than single stent deployment.
