PMC8060700_01
Angiographies of the intervention. (A) Angiography from the femoral artery. The small duct is slightly contrasted, but no contrast medium crosses the stenosis of the CoA. (B) The ironman wire through the right axillary sheath is snared in the descending aorta and the pre-mounted stent is in position (arrow) after pre-dilation of the CoA with a 2.5 mm coronary balloon. Contrast medium is applied through the 4F axillary sheath into the truncus brachiocephalicus. The non-inflated balloon completely obstructed the CoA. (C) Angiography after stent implantation with good position. A 4F multipurpose catheter is placed from the venous side in the small PDA (not contrasted).
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F1
However, a guide wire could not be advanced across the CoA due to the severity of the stenosis (Figure 1A). Angiography revealed extreme CoA and the pre-mounted stent completely occluded the lumen with angiographically no visible forward flow to the DAO (Figure 1B). The angiography showed the desired result with a harmonically modeled stent and a mild residual gradient of 17 mmHg (Figure 1C).
Post-intervention echocardiography. (A) Stent visualization in the descending aorta. Proximal stent struts (red arrow) partially cover the opening of the left subclavian artery (LSA) without obstruction. (B) Flow acceleration over coronary stent in isthmus region with 4.1 m/s.
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F2
Despite clinical improvement, echocardiography still showed a peak gradient over the stent of 64 mmHg (Figure 2) so that surgical therapy was still indicated.
Intraoperative images. (A) Situs after stent implantation, showing transverse aortic arch (TAA), left subclavian artery (LSA) and descending aorta (DAO) and persistent ductus arteriosus (PDA). (B) Stent in the isthmus region. (C) Resection of coarctation with stent. (D) Surgical result.
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F3
The stent was easily removed during surgery (Figures 3A-D).