Coarctation of the Aorta: An Atypical Case Treated by a Double Layer Stent Technique

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.