aortic coarctation is a rare disease entity in adults and a reversible cause of hypertension.1 ) because surgical management is relatively invasive and has the possibility of serious complications such as paraplegia , paroxysmal hypertension , re - coarctation and aneurysms , percutaneous stent implantation has become a popular alternative.2)3 ) research into which type of stent should be standard for coarctation has been inconclusive but in limited patients with turner 's syndrome or hypoplastic aortic arch , and in those suspected to have fragile blood vessels , treatment with a covered stent is recommended.4)5 ) however , covered stenting leads to the potential risk of critical complications such as occlusion of left subclavian artery , which may lead to acute paraplegia.6 ) moreover , there are currently no flexible covered stents available in korea as imports . instead , there are several bare metal stents ( bms ) for aortic coarctation available , made out of shape memory nitinol . these have the advantage of flexibility and conformability , as well as being safe in terms of vessel wall damage as they have soft ends . unless there is clear evidence of fragile vessels , implantation of bms may be another cost - effective and safe treatment option . this is the first report describing a case successfully managed by transcatheter treatment of aortic coarctation in an adult patient using bms who had finished one year clinical follow - up at the time of writing . a 47-year - old man presented to our hospital due to sustained headache and uncontrolled hypertension . his hypertension was poorly controlled despite a combination of three different antihypertensive agents ( candesartan 16 mg dp , amlodipine 5 mg dp and hydrochlorothiazide 12.5 mg dp ) . physical examination showed a blood pressure of 140/80 mm hg in both arms , a heart rate of 69 beats / minute and no audible murmur . his echocardiogram showed enlarged sinus portion of ascending aorta with moderate aortic regurgitation ( grade 3 ) , suspicious of aortic aneurysm , but left ventricular systolic function was well preserved . due to the significantly enlarged sinus portion of ascending aorta , the patient underwent multislice spiral computed tomography ( ct ) angiography for evaluation of aorta anatomy . ct angiography showed focal significant stenosis of the descending aorta , just below the left main pulmonary artery level with vigorous collateral blood flow ( fig . invasive aortography was then performed , which showed severe aortic coarctation distal to the origin of subclavian artery ( fig . according to the quantitative aortography measurements , the coarctation segment was a minimum of 8 mm in diameter and 40 mm in length . the diameters of the thoracic aorta above and below the coarctation segment were 19 and 22 mm , respectively . the patient was then planned for elective percutaneous balloon dilatation with subsequent stent implantation . under the local anesthesia , a 7 fr arterial sheath was inserted into the right femoral artery and then in sequence a 5 fr arterial sheath was also inserted into the left femoral artery . after this , a 5 fr pigtail catheter was placed at the coarctation segment following successful wiring with a 0.035 inch terumo guidewire ( terumo , tokyo , japan ) . afterwards , multiple predilatation with an 840 mm powerflex balloon ( johnson & johnson , miami , fl , usa ) was applied to the coarctation segment . an aortic stent was successfully deployed using a 2250 mm self - expandable nitinol stent ( hercules vascular stent , s&g , seongnam , korea ) ( fig . 3 ) . further to this , post - dilatation with a 1240 mm ultrathin balloon ( boston scientific , natick , ma , usa ) was carried out . immediate after the stenting , final aortography revealed adequate patency of the stent in the coarctation segment of the thoracic aorta and showed correct device position without any dissection or perforation , with the diameter of the isthmus increased from 8 to 16 mm ( fig . the patient has been prescribed acetyl salicylic acid 100 mg per day , which was continued until the latest visit . clinical follow - up was performed at 1 , 3 and 6 months after the procedure then continued at 4-month intervals . the patient 's hypertension was well controlled using fewer antihypertensive medications on follow - up and his subjective symptoms disappeared shortly after the procedure . to date , the patient has been followed for 12 months in good clinical condition . follow - up multislice spiral ct angiography was performed at six months after the procedure and showed no significant re - stenosis within the stent of coarctation segment . further , occlusion of abdominal aorta branches , aneurysm formation , or other related complications were not observed . ct angiography also showed tremendously diminished collateral blood flow compared with pre - procedural images ( fig . aortic coarctation is a congenital vascular lesion that is diagnosed in childhood in most cases , and accounts for 5 to 10% of all congenital cardiovascular malformations.7 ) however , it may sometimes not be diagnosed easily until adulthood.8 ) the clinical manifestations are distinguished according to the age groups . heart failure is not frequent beyond the neonatal period , thus most infants and children also remain asymptomatic , leading to delayed diagnosis . in adults , . there could be significant variability in measuring blood pressure in the upper and lower extremities but regional blood flow is usually well retained by the autoregulatory system . most adult patients are also asymptomatic till severe hypertension give rise to headache , epistaxis , heart failure , or aortic dissection . additionally , claudication may occur due to reduced blood flow to the lower extremities.9 - 11 ) in 2008 , the american college of cardiology and american heart association suggested guidelines for adults with coarctation . the recommended indications for intervention include a high peak to peak coarctation gradient , anatomic imaging evidence of coarctation and radiologic evidence of significant collateral blood flow . yet even in these guidelines , the optimal treatment for coarctation of the aorta in adults is left open to debate.12 ) the endovascular technique for adult aortic coarctation has obtained a widespread popularity since the mid-1990s . in 2006 , carr13 ) published a comparison between angioplasty ( stent , balloon dilatation or a combination ; n=633 ) and surgery ( n=213 ) in adult aortic coarctation patients , based on papers published during 1995 - 2005 . stenting had the lower morbidity ( mean 9% , range 0 - 20% ) , whereas morbidity was slightly higher in the surgical group ( mean 11% , range 0 - 25% ) , mainly related to bleeding and recurrent laryngeal nerve injury . restenosis was found in 11% ( range 0 - 25% ) in the stented group , but in only 2% ( range 0 - 9% ) in the surgical group . however , it is difficult to make recommendations because stent technology has progressed over time , producing superior stent designs . it may be necessary to set up a multicentre prospective randomized clinical trial comparing surgical modality to stenting in order to ascertain what is the best management method for aortic coarctation in adults.14 ) safety is one of the major advantages of percutaneous intervention , compared to surgical treatment . however , intervention techniques do have some potentially serious complications . deaths related to aortic rupture and dissection during procedure are very rare,13)15 ) but other complications also exist . in many cases , authors report device migration and vascular injuries at the site of arterial cannulation . stent fractures and balloon rupture are also potential complications of percutaneous intervention . covered stents are preferentially used for patients at risk of complications due to complex anatomy or advanced age.14 ) however there are several disadvantages , such as relatively small sheath size and potentiality of supra - aortic branch occlusion.16)17 ) the wide cost gap between bms and covered stents is also problematic . however , to our knowledge , there is no single randomized control trial comparing between bms and covered stent in mid - aged otherwise healthy candidates . as found in our case report , bms can be safely deployed in selected patients and , moreover it has obvious advantage in terms of cost . efficacy and safety comparisons between the two types of stents will be needed to confirm the optimal modality for the treatment of aortic coarctation in adults .
aortic coarctation is a correctable hypertensive disease . for safety reasons and due to the invasiveness of surgical techniques , 
 percutaneous interventions have become drastically more popular in recent times . in elderly patients with aortic coarctation who are at risk of an aortic wall aneurysm and rupture , covered stents are preferred but in younger patients 
 , bare metal stenting may be sufficient for long - term safety . 
 herein we present a 47-year - old typical aortic coarctation patient who was successfully treated with a bare metal stent .