More inside stenting in aortic coarctation: the sequential stent dilation

We still remember the case of a 44-year-old male patient transferred to our hospital because of thoracic pain, with a previous medical history of treatment for aortic coarctation (CoA) by a surgical aortoplasty at 8-year-old followed by surgical aortic reconstruction at 18's for aortic recoarctation (Re-CoA). He underwent a computed tomography angiography (CTA) showing a pseudoaneurysm in the site of previous aortic reconstruction, with an important mismatch in the diameter of the aortic arch and the descending thoracic aorta, making impossible the treatment by thoracic endovascular aneurysm repair (TEVAR) with a landing in zone 2 or 1. After a case discussion by the aortic team, an open surgical reconstruction by a third thoracotomy was excluded, due to the high risk of such approach. Whereby, we treated this patient using a hybrid approach with a supra-aortic branches with sternotomy, followed by TEVAR in zone 0 adopting conical thoracic endografts to overcome the aortic diameter mismatch. Despite the good surgical outcome of this patient, the main encountered problem in the postoperative course was many difficulties on arterial systemic pressure control which was controlled by the use of aggressive antihypertensive drugs.