Successful management of a proximally migrated stent in a middle-aged woman with unnoticed native aortic coarctation

Abstract

Endovascular stent placement for adults with a newly diagnosed native discrete post-subclavian aortic coarctation (AC) became widely acceptedas an alternative to surgery,despite thatthe efficacyand long term safety of the technique have not yet been well established [1]. Placement of stent can be technically challenging and has been associated with serious complications, such as acute aortic rupture (rare), aortic dissection, femoral artery trauma, subacute stent thrombosis, recurrent coarctation, and aneurysm formation [2]. There is a paucity of data regarding stent migration, its causes; and its management has not been well defined. Proximal migration of a (covered) stent is a very rare occurrence [3]. To our knowledge, no previous reports of a proximally migrated covered stent and its successful repositioning using a peripheral balloon catheter during transcatheter management of AC in an adult have been published. We report a woman with a native AC whose treatment was complicated by stent migration proximally, which was then successfully repositioned at the expected site by transcatheter technique. A 45-year-old woman was referred for catheterization after her diagnostic work-up for resistant hypertension suggested renal artery stenosis. Her past medical history was notable for a 10-year history of hypertension. She had no other history of cardiovascular disease. She had hadtwo prior pregnancies,with ahistoryof hypertension requiring no drug therapy. Her medical regimen included nebivolol, lercanidipine, irbesartan, hydrochlorothiazide, and atorvastatin at the time of presentation. A thorough physical examination was performed, revealing the blood pressure difference between the right arm and leg of 30 mm Hg in the presence of systemic hypertension, a radial–femoral pulse delay with weak lower limb pulses, and faint mid-systolic murmur over the chest and back. Her electrocardiogram was normal with no evidence of left ventricular hypertrophy or ischemia. Echocardiography demonstrated left atrial dilatation, moderate mitral regurgitation, with an estimated left ventricular ejection fraction of 65%. However, gradient measurement by continuous wave Doppler was not obtainable. No other associated abnormalities were detected.