Palmaz Stent Research Articles

Cheatham Platinum (CP) and Palmaz stents for cardiac and vascular lesions treatment in patients with congenital heart disease

To compare Cheatham Platinum (CP) stent and Palmaz stent for the treatment of native and postoperative lesions of congenital heart disease (CHD) patients. From January 1998 to December 2007, 96 CP stents and 77 Palmaz stents were implanted in 89 and 64 CHD patients. All stents could be deployed. Decrease in pressure gradient was higher with the CP than with the Palmaz stent (36.1 +/- 23 and 23.4 +/- 18.3 mmHg, p = 0.004). The procedure was more often successful with a CP than with a Palmaz stent (96% and 88% of patients, p = 0.03). Stent-related complications were more rarely observed with the CP than with the Palmaz stent (9% and 27%, p = 0.007). The incidence of vascular dissection was lower with CP than with Palmaz stent (1% and 6%), the incidence of stent migration was similar in the two groups (8% and 6%). Balloon burst, never observed in the CP stent group, was frequent in the Palmaz group (0% and 11%, p = 0.001). There were no procedural deaths. The need for urgent surgery was similar in the two groups (2% and 1%). Our findings show a superiority of the CP over the Palmaz stent concerning efficacy and reduction of complications rate for the treatment of cardiac and vascular lesions of children and young adults with CHD.

Long segment congenital tracheal stenosis in twins successfully treated by slide tracheoplasty

Long segment congenital tracheal stenosis (LSCTS), associated with complete tracheal rings, is a rare condition, difficult to manage and historically associated with high mortality rate. We report two pairs of identical twins all affected by LSCTS successfully treated by sliding tracheoplasty. All had severe respiratory distress. Three infants had left pulmonary artery (LPA) sling and one intra-cardiac malformation. Slide tracheoplasty was done under cardiopulmonary bypass, and cardiovascular malformations were corrected at the same time. One child needed plication of paralyzed right hemi-diaphragm and another distal tracheal Palmaz stent insertion due severe tracheobronchomalacia. All children are doing well during 6 months follow-up. Slide tracheoplasty seems to produce the same good early results in twins as for singletons with LSCTS.

In vitro in‐stent restenoses evaluated by 3D ultrasound

The purpose of this study was to quantify in-stent restenoses with 3D B mode and power Doppler ultrasound (U.S.) imaging. In-stent restenoses were mimicked with vascular phantoms in which a nonferromagnetic prototype stent (Boston Scientific) and a ferromagnetic clinical stainless steel stent (Palmaz P295) were embedded. Each phantom had an 80% in-stent stenosis and a 75% stenosis located outside the stent. These phantoms were compared to a reference phantom reproducing both stenoses without stent. Data sets of 2D cross-sectional U.S. images were acquired in freehand scanning using a magnetic sensor attached to the U.S. probe and in mechanical linear scanning with the probe attached to a step motor device. Each 2D image was automatically segmented before 3D reconstruction of the vessel. Results indicate that the reference phantom (without stent) was accurately assessed with errors below 1.8% for the 75% stenosis and 3.2% for the 80% stenosis in both B mode and power Doppler for the two scanning methods. The 80% in-stent stenoses in Boston Scientific and Palmaz stents were, respectively, evaluated at 73.8 (+/-3.2)% and 75.8 (+/- 3)% in B mode and at 82 (+/- 2.5)% and 86.2 (+/- 6.4)% in power Doppler when freehand scans were used. For comparison, when linear scans were selected, in-stent stenoses in the Boston Scientific or Palmaz stent were, respectively, evaluated at 77.4 (+/- 2.0)% and 73.8 (+/- 2.5)% in B mode and at 87.0 (+/- 1.3)% and 85.6 (+/- 5.8)% in power Doppler. To conclude, 3D freehand U.S. is a valuable method to quantify in-stent restenoses, particularly in B mode. It is thus hoped that, in the clinical setting, noninvasive 3D U.S. may provide sufficient precision to grade in-stent restenoses.

Fenestrated endovascular repair for juxtarenal aortic pathology

To evaluate the outcomes after fenestrated endovascular aortic repair (f-EVAR) in a tertiary European referral center. All patients treated with commercially available custom-made f-EVAR between September 2002 and June 2007 were prospectively enrolled in a computerized database including co-morbidities and aneurysm morphology. Patients were retrospectively analyzed. Follow-up consisted of clinical examinations and computed tomography (CT) scanning. A total of 54 patients were included in this study. Median age was 72 (interquartile range [IQR] 68-76) years and 85% were men. Median preoperative aneurysm diameter was 60 (53-66) mm. One hundred thirty-four vessels were targeted (43 scallops, 91 fenestrations) and 96 stents were placed (69 bare, 27 covered). Target vessel catheterization was achieved in 98% of cases. Two patients (3.7%) died within 30 days, 1 from trash embolization and multiorgan failure and 1 from retroperitoneal bleeding caused by a renal artery perforation. Three type I endoleaks occurred intraoperatively, two sealed pre-discharge and one was treated with a Palmaz stent (Cordis, Miami Lakes, Fla) on postoperative day 4. Thirteen patients had type II endoleaks, and 2 required treatment. The median clinical follow-up was 25 (12-32) months with median CT follow-up of 22 (4-26) months. Aneurysm diameter decreased >or=5 mm in 47%, was unchanged in 50%, and increased >or=5 mm in 3% of patients at 1 year. There were three type II endoleaks at 1-year follow-up, one of which was successfully treated after 19 months due to aneurysm growth. Ninety-six percent of target vessels remained patent during the study period and all occlusions occurred within the first year of follow-up. Five target vessels occluded (2 renal arteries [RAs] and 3 superior mesenteric arteries [SMAs]) without symptoms during follow-up and successful reinterventions were done on 2 stenosed RAs. Three patients suffered creatinine increase but none needed dialysis. One late aneurysm-related death occurred due to massive bleeding during redo surgery for infection. Despite complex anatomy or severe comorbidities in these patients f-EVAR has acceptable short- and midterm results in this series which includes a learning curve and offers a valid treatment alternative to patients unsuitable for standard EVAR or open repair.

Percutaneous portal venoplasty and stenting for anastomotic stenosis after liver transplantation

To review percutaneous transhepatic portal venoplasty and stenting (PTPVS) for portal vein anastomotic stenosis (PVAS) after liver transplantation (LT). From April 2004 to June 2008, 16 of 18 consecutive patients (11 male and 5 female; aged 17-66 years, mean age 40.4 years) underwent PTPVS for PVAS. PVAS occurred 2-10 mo after LT (mean 5.0 mo). Three asymptomatic patients were detected on routine screening color Doppler ultrasonography (CDUS). Fifteen patients who also had typical clinical signs of portal hypertension (PHT) were identified by contrast-enhanced computerized tomography (CT) or magnetic resonance imaging. All procedures were performed under local anesthesia. If there was a PVAS < 75%, the portal pressure was measured. Portal venoplasty was performed with an undersized balloon and slowly inflated. All stents were deployed immediately following the predilation. Follow-ups, including clinical course, stenosis recurrence and stent patency which were evaluated by CDUS and CT, were performed. Technical success was achieved in all patients. No procedure-related complications occurred. Liver function was normalized gradually and the symptoms of PHT also improved following PTPVS. In 2 of 3 asymptomatic patients, portal venoplasty and stenting were not performed because of pressure gradients < 5 mmHg. They were observed with periodic CDUS or CT. PTPVS was performed in 16 patients. In 2 patients, the mean pressure gradients decreased from 15.5 mmHg to 3.0 mmHg. In the remaining 14 patients, a pressure gradient was not obtained because of > 75% stenosis and typical clinical signs of PHT. In a 51-year-old woman, who suffered from massive ascites and severe bilateral lower limb edema after secondary LT, PVAS complicated hepatic vein stenosis and inferior vena cava (IVC) stenosis. Before PTPVS, a self-expandable and a balloon-expandable metallic stent were deployed in the IVC and right hepatic vein respectively. The ascites and edema resolved gradually after treatment. The portosystemic collateral vessels resulting from PHT were visualized in 14 patients. Gastroesophageal varices became invisible on poststenting portography in 9 patients. In a 28-year-old man with hepatic encephalopathy, a pre-existing meso-caval shunt was detected due to visualization of IVC on portography. After stenting, contrast agents flowed mainly into IVC via the shunt and little flowed into the portal vein. A covered stent was deployed into the superior mesenteric vein to occlude the shunt. Portal hepatopetal flow was restored and the IVC became invisible. The patient recovered from hepatic encephalopathy. A balloon-expandable Palmaz stent was deployed into hepatic artery for anastomotic stenosis before PTPVS. Percutaneous transhepatic internal-external biliary drainage was performed in 2 patients with obstructive jaundice. Portal venous patency was maintained for 3.3-56.6 mo (mean 33.0 mo) and all patients remained asymptomatic. With technical refinements, early detection and prompt treatment of complications, and advances in immunotherapy, excellent results can be achieved in LT.

Fifteen years’ experience with transjugular intrahepatic portosystemic shunt (TIPS) using bare stents: retrospective review of clinical and technical aspects

The authors present a retrospective analysis of a large series of patients who underwent transjugular intrahepatic portosystemic shunt (TIPS) placement. Between March 1992 and December 2006, 658 patients were referred to our centre for TIPS placement. Indications for the procedure were digestive tract bleeding (52.8%), refractory ascites (35.3%), preservation of portal vein patency prior to liver transplantation (3.0%) and thrombosis of the suprahepatic veins (2.3%). Other indications (6.6%) included pleural ascites, portal thrombosis and hepatorenal and hepatopulmonary syndromes. All patients were evaluated with colour Doppler ultrasonography and in a few cases with computed tomography. The portal system was punctured under sonographic guidance. Wallstent, Palmaz and Nitinol thermosensitive stents were used. Embolisation of persistent varices was performed in 6.8% of cases. Technical success was 98.9%. During a 1,500-day follow-up, the cumulative incidence of stent revision was 25.7% (Nitinol), 32.9% (Wallstent) and 1.8% (Palmaz). Mortality rates were 31.1%, 38.5% and 56.4%, respectively. The technical complications included six cases of heart failure, six of haematobilia, three of stent migration, two of intrahepatic haematoma and one of haemoperitoneum. Eight patients with severe portosystemic encephalopathy (PSE) were treated with a reduction stent. TIPS placement is safe and effective and may act as a bridge to liver transplantation. Ultrasonography plays a fundamental role in the preliminary assessment, in portal vein puncture and during the follow-up. Stent patency is satisfactory.

Endovascular repair of stent graft collapse by stent-protected angioplasty using a femoral-brachial guidewire

This report aims to describe an effective endovascular technique to repair a stent graft collapse in the distal aortic arch. We report a case of a stent graft collapse after off-label endovascular treatment of a traumatic aortic transection using a Gore TAG endoprosthesis (oversizing 12%). The collapse was treated by off-label stent-protected angioplasty (Palmaz stent, Cordis, Miami, Fla) over a stiff guidewire, which was passed from the right femoral artery through the collapsed stent graft and out at the right brachial artery. We believe that this technique enables more precise stent deployment and is safer than the regular guidewire position in the ascending aorta.

Stenting the paediatric heart

The concept of intravascular stent implantation was first described by Dotter et al in 1969 in an animal model.1 However, balloon expendable intravascular stenting was not carried out until two...

A technique for increased accuracy in the placement of the “giant” Palmaz stent for treatment of type IA endoleak after endovascular abdominal aneurysm repair

We report a deployment technique that eliminates "watermelon seeding" of the "giant" Palmaz stent in the treatment of type IA endoleak after endovascular abdominal aneurysm repair. A 5010 Palmaz stent (Cordis Corp, Miami Lakes, Fla) is asymmetrically hand-crimped on an appropriately sized valvuloplasty balloon that assures that the proximal (cranial) aspect will deploy first. A long 16 to 20F sheath is placed distal to the target area. Once the balloon and stent assembly is in position, the sheath is partially retracted to allow only the proximal (cranial) half of the balloon to expand, flaring the unsheathed proximal stent. The expanded proximal balloon prevents cranial stent migration. The sheath prevents distal (caudal) stent migration. Full retraction of the sheath allows the distal balloon and stent to expand, completing the stent deployment.

Experience With the Endologix Powerlink Endograft in Endovascular Repair of Abdominal Aortic Aneurysms With Short and Angulated Necks

Endovascular aortic aneurysm repair (EVAR) for anatomically suitable abdominal aortic aneurysms (AAAs) has gained wide acceptance in the past decade, and EVAR for anatomically challenging or unsuitable AAAs such as short and angulated neck AAAs has become a hotly debated subject. The objective of this study is to summarize the unique experience of EVAR for short / angulated neck AAAs with Powerlink unibody bifurcated stent-graft. Data were retrospectively analyzed from 519 patients in our single unit from February 1999 to December 2007 who underwent EVAR using the Powerlink endograft, and had short or angulated necks. Short neck was defined as < or = 15 mm for the infrarenal neck length, and it was divided into 2 groups: Group A (short neck), 54 cases with the length 11 to 15 mm; and Group B (very short neck), 26 cases with the length < or = 10 mm. Angulated neck of 37 cases which was defined as > or = 60 degrees angulation between the longitudinal axis of infrarenal aorta and the aneurysm. The unique strategy of treating short / angulated neck AAAs is to build up the endoluminal exclusion system from the native aortic bifurcation to the renal artery level with suprarenal fixation. The Powerlink unibody bifurcated stent graft was implanted anatomically fixed on the aortic bifurcation and a long suprarenal cuff was built up to the renal arteries. A Palmaz stent can be used for proximal fixation and sealing enhancement in the most challenging necks. The follow-up imaging was performed at 1 month, 6 months, and yearly thereafter. The technical success rate was 97.4% (114/117). Intraoperative complications included 3 conversions due to delivery access problems, 6 proximal type I endoleaks, and 5 type II endoleaks. The 30-day mortality was 1.7% (2/117). The 2.6-year follow-up showed 4 (3.4%) proximal type I endoleaks, which were revised with proximal cuff and/or Palmaz stent. Limb occlusion occurred in 2 cases, and the total re-intervention rate was 5.3%. Three (2.6%) type II endoleaks were left in observation. There were 3 (2.6%) partial renal infarctions, no stent-graft distal migration, and no post-EVAR ruptures. Our experience demonstrates that building up the endoluminal exclusion system from the abdominal aortic bifurcation to the renal artery level using the Powerlink fully supported unibody bifurcated stent-graft with a long suprarenal cuff, and a Palmaz stent when needed, proved safe and effective in treating AAAs with short and angulated necks.

Abstract No. 239: Non-Aneursymal Acute Aortic Syndromes – 3D CT Imaging Features for Interventional Management

To review and audit our single institution experience to-date in endovascular repair of thoracic aortic pathology. A formal thoracic aortic stent programme was inititated in June 2006 by the radiology department in collaboration with the national cardiothoracic center and vascular surgery departments. Prior to this a number of stents had been performed electively by the cardiology and cardiothoracic services. We prospectively recorded the patients treated by radiology and retrospectively reviewed clinical, imaging and follow up data on all patients. A total of 29 patients were treated over 2 years. The underlying thoracic conditions included aneurysm, dissection, pseudoaneurysm, transaction and aorto-bronchial fistula. Radiology performed 10 stents in 9 patients over 12 months and all the emergency cases. 8 TAG (Gore), 2 Palmaz and 6 Valiant (Medtronic) stents were employed. Cardiology performed 14 Palmaz stents for Coarctations. All had pre-procedure and follow-up 2D and 3D CT angiography. All patients had successful stenting procedures. There was one death in a patient of high risk and multiorgan dysfunction pre-procedure. There were 2 stent foldings/kinks one of which required angioplasty and balloon mounted stent. There were no stent migrations or endoleaks. There was no paraparesis or paralysis from stent procedures. Non-stent complications included 1 surgical bypass which thrombosed requiring re-operation. Thoracic aortic stenting has been performed with consistent clinical success in our institution for a variety of non-aneurysmal aortic pathologies. Results compare favourably to international standards. The radiology department has provided a reliable diagnostic and therapeutic service over the last 12months with good results in the elective and emergency setting.

Endovascular Treatment of Chronic Mesenteric Ischemia

Endovascular procedure is frequently used as an alternative to surgical bypass in aortic atherosclerotic lesions. Two rare cases of chronic mesenteric ischemia treated with a stent implantation are reported. The patients were a 72-year-old woman and a 57-year-old woman. They presented with severe abdominal pain after meals, repeatedly. Angiography revealed severe stenosis and occlusion of the super mesenteric artery (SMA). Endovascular treatment was initially and technically successful in both patients. A Palmaz stent was deployed in the ostium lesion of the SMA for both cases. Completion angiography showed successful recanalization of the SMA without any complication and with satisfactory distal flow. The patients' symptoms were alleviated. They remained asymptomatic after stent implantation. Primary stenting may be considered a viable alternative to conventional surgery in carefully selected patients with chronic mesenteric ischemia due to SMA stenosis.

Percutaneous Stenting of Superior Vena Cava Syndrome: Treatment Outcome in Patients with Benign and Malignant Etiology

Symptomatic obstruction of the superior vena cava (SVC) can be caused by either intrathoracic malignancy or nonmalignant etiology resulting in superior vena cava syndrome (SVCS). The objective of this study was to evaluate the clinical outcome of percutaneous stenting of SVCS in patients with malignant and benign disease. During a 9-year period, 56 patients with SVCS underwent percutaneous stenting placement. Among them, malignant and benign disease was responsible for 40 patients (71%) and 16 patients (29%), respectively. The Wallstent was the most commonly used stent and was used in 45 patients (80%), whereas the Palmaz stent was used in 6 patients (11%). In 38 patients (68%), a single stent was deployed to treat an SVC lesion. In contrast, bilateral kissing stents were deployed in 9 patients (16%), which extended from bilateral brachiocephalic veins to the proximal SVC. Technical success was achieved in all patients while symptomatic improvement was noted in 54 patients (96%). No procedural complications occurred in this series. Primary patency in malignant and benign cases at 1 year was 64% and 76%, respectively. Overall symptom-free survival ranged from 1 to 34 months. Our study showed that endovascular treatment with percutaneous stenting provides an effective treatment strategy in patients with SVCS caused by either malignant or benign disease.

Diagnostik und endovaskuläre Behandlung einer proximalen Endograft-Instabilität nach thorakalem Endostent

Four cases of proximal endostent instability after endovascular tube graft treatment of thoracic aortic disease using the TAG Gore system are reported. This potentially hazardous complication is characterized by a lack of attachment of the device to the small curvature of the aortic arch. Towering up against the hemodynamic forces in this area, the endograft could collapse and occlude the aorta. To identify this complication we recommend to perform an early postinterventional CT-scan with parasagittal reconstruction and an observation of the proximal endograft by fluorography. Endovascular solutions for the treatment of this complication may be either a proximal extension by another endograft or fixation of the proximal endograft by a balloon expandable Palmaz stent.

Endovascular conversion with femorofemoral bypass as a treatment of endotension and aneurysm sac enlargement

We report a case of a patient treated with a Gore Excluder endograft for AAA in November 2003 with subsequent aneurysm sac enlargement in the absence of an identified endoleak. The patient had a Type I endoleak treated with a Palmaz stent at the neck and later developed a Type II endoleak treated with translumbar coil embolization. This was successful with absence of pressure in the sac after the procedure and stable aneurysm size over the next nine months. Surveillance of the patient with both CT and ultrasound then revealed an increase in the aortic sac diameter in the absence of endoleak. A Cook Zenith converter was used to reline this PTFE endograft. Subsequently, imaging showed aneurysm sac shrinkage. This is a report of endotension with aneurysm expansion following Gore Excluder placement which was treated successfully with a dacron endograft.

Stent fracture in revascularization for symptomatic ostial vertebral artery stenosis

We assessed the long-term follow-up examinations and complications of percutaneous transluminal angioplasty and stenting (PTAS) for symptomatic ostial vertebral artery (VA) stenosis. A retrospective study was done to evaluate 12 patients with symptomatic ostial VA stenosis who underwent PTAS. Six patients were treated with the Palmaz stent and six with a balloon-expandable coronary stent. Initial angiographic follow-up examination was conducted about 12 months after PTAS in all patients. Simple radiographic, ultrasonographic and clinical follow-up examinations were scheduled every 6 months. Excellent dilatation was achieved in all patients without any procedural complications. Initial angiographic follow-up obtained at a mean of 13 months after PTAS detected no restenosis. However, an asymptomatic severe restenosis was detected at 24 months after PTAS in one patient (8%). During a mean follow-up of 31.5 months, three stent fractures were detected in deployed coronary stents (50%). None of the stent fractures was associated with either recurrent stroke or restenosis. No patients developed recurrent symptoms during the follow-up period. PTAS for symptomatic ostial VA stenosis is effective in preventing recurrent stroke. As the open-cell single-joint type of stent is associated with the risk of fracture, long-term follow-up examinations including simple radiography are needed.

In Vitro Evaluation of a New Autologous Valve-Stent for Deep Venous Incompetence

To report the results of in vitro hydrostatic bench testing of a new vein-stent combination to correct deep venous incompetence. Twelve valves were constructed from a modified Palmaz stent encased in a segment of great saphenous vein harvested from patients during routine varicose vein surgery. An in vitro flow circuit was set up to evaluate opening and closing pressures (in cm H(2)O), and the valve was subsequently subjected to repetitive cycles of increasing prograde flow and reflux pressures. Duplex scanning was used to evaluate valve closure time and detect any possible reflux. The valve mechanism required only 1 to 3 cm H(2)O for opening and 2 to 4 cm H(2)O for closing. Prograde flow of up to 1000 mL/min passed easily through this valve, which remained competent with reflux pressures up to 180 cm H(2)O. Mean valve closure time was 0.15+/-0.07 seconds. Unligated side branches or damage from dissection impaired the competence of 3 valves. This new vein-stent valve functions as a normal deep vein valve, requiring only minimal pressures for opening and closing. It allows high flow passage and still remains competent at high reflux pressures. This valve may provide a minimally invasive solution for the correction of deep venous incompetence using autologous material. Further in vivo evaluation will be mandatory.

Treatment of Secondary Stent-Graft Collapse After Endovascular Stent-Grafting for Iliac Artery Pseudoaneurysms

We report the case of a patient who developed an asymptomatic pseudoaneurysm in the left external iliac artery after transplant nephrectomy. The pseudoaneurysm most probably arose as a suture aneurysm from the external iliac artery after removal of the graft renal artery. Obviously we can not exclude the possibility it was a true aneurysm, although this seems much less likely. The pseudoaneurysm was detected during a routine CT scan and was treated interventionally with a stent-graft. One month later the asymptomatic patient underwent a vascular ultrasound examination including color Doppler, power Doppler, and B-flow as a routine control. An endoleak with collapse of the stent-graft was diagnosed. There was no evidence of stent infection. At a reintervention, the pseudoaneurysm was successfully treated using two uncovered Palmaz stents at the proximal and distal edge of the stent graft. Peri- and post-interventional ultrasound and CT angiography confirmed the exclusion of the aneurysm without an endoleak.

Development of a reexpandable covered stent for children

The use of covered stents in children is limited by the need for a large long sheath for delivery and the impossibility of redilation once implanted. The authors developed a reexpandable covered stent implantable in children through a small sheath and evaluated its clinical feasibility in mini piglets. An original Palmaz stent was covered with a polyurethane membrane that could be stretched up to 700%. Under general anesthesia, the authors implanted the covered stents in six mini piglets using a long sheath with a diameter approximately 1 French larger than the recommended size required to deliver an uncovered Palmaz stent. The implantation technique was similar to conventional stent implantation. In six piglets, the stent could be redilated from 7.5 to 8.7 mm 28-70 days after implantation. Macroscopic and microscopic examination showed intimal coverage of the coating with minimal inflammatory reaction around the stent. Our newly designed reexpandable stent covered with a polyurethane membrane is promising for use in children.

Endovascular Approaches for Complex Forms of Recurrent Aortic Coarctation

To review a single-center experience with endovascular treatment of recurrent aortic coarctation in adults. Since 1998, 11 patients (9 men; mean age 48+/-15 years, range 16-63) with recurrent aortic coarctation following previous coarctation repair were referred to our institution for treatment. Clinical presentations included pseudoaneurysm (n=2), restenosis (n=3), pseudoaneurysm accompanied by restenosis (n=4), and rupture of a post-coarctation pseudoaneurysm (n=2). All patients were treated using an endovascular approach as part of a single-center investigational device exemption protocol. Endovascular interventions included Palmaz stent implantation (n=3), implantation of an endoluminal graft (n=2), or a combination of both treatments in 6 patients. Three patients underwent balloon angioplasty before stenting or endografting, and 2 patients had a carotid-subclavian bypass done before the endovascular repair. All repairs were technically and clinically successful. The median length of stay after repair was 2.0+/-2.3 days. In follow-up, 2 patients underwent a carotid-subclavian bypass for left upper extremity claudication. Two patients required reintervention owing to migration of the stent in 1 and an endoleak 2 years after the initial procedure in the other. Endovascular approaches to adult coarctation appear to be safe and effective. With the emergence of endoluminal grafts and the widespread availability of the Palmaz stent, endovascular repair offers an excellent alternative to open surgery for complex cases of recurrent coarctation. Additional studies are indicated to assess the long-term outcomes of these patients.