Because of its complications, the coarctation of the aorta can benefit of medical, surgical, or interventional (minimally invasive) treatment : either by the dilatation of the narrowed segment using a balloon (balloon angioplasty), or by the insertion of a stent (a small thin metallic device, like a tube – the procedure is called stent angioplasty), which maintains the vessel to its normal dimensions.
Indications for treatment : include heart failure, hypertension, and the existence of a pressure gradient (pressure difference between the segment behind the stenosis and the segment after the stenosis) ≥20 mmHg (at rest) or even lower values if radiologic findings suggestive of high collateral flow (the opening of new vessels) are found, in case of progressive left ventricular hypertrophy (the thickening of the heart walls) and impairment of left ventricular function, or association of other abnormalities requiring specific treatment (valvular diseases, aortic aneurysm, septal defects..)
As far as the treatment method is concerned, it is chosen depending on the age at presentation and the anatomy of the coarctation (the aspect of the lesion), also of the neighbouring structures (the association with other defects).
How is the optimal treatment established?
As specified above, important determinants when choosing the best treatment strategy are the age of the patient and the anatomy of the stenosed segment.
Thus,
• depending on the age at presentation:
For the newborn and infant : surgical intervention and minimally invasive treatment – balloon dilation.
For the child (>25 kgs), the adolescent, and the adult : stent angioplasty is indicated.
• depending on the aspect of the lesion:
Long coarctation segments can be managed either surgically or by stent implantation.
Discrete or recurrent coarctation (after previous surgical intervention or balloon dilation) can either benefit of a new dilation, or a stent angioplasty may be performed.
The stent is preferred for: long segments of coarctation, associated istmic hypoplasia or of the aortic arch (insufficiently developed initial segments of the aorta), bending of the involved segment, coarctation recurrence (re-narrowing), or aneurysm formation after a previous intervention (either surgical or balloon dilation)