Self-expanding aortic endografts for endovascular repair of native and recurrent coarctation of the aorta

OBJECTIVES: Endovascular repair of coarctation of the aorta (CoA) can be challenging in the presence of arch angulation, post-stenotic dilation, or prior surgical repair, which may limit the performance of balloon-expandable covered stents. To address these anatomic constraints, the authors evaluated the use of a self-expanding thoracic aortic endoprosthesis for CoA repair. METHODS: The authors performed a multicenter retrospective review of patients who underwent endovascular repair of native or recurrent CoA using the GORE TAG Thoracic Branch Endoprosthesis Extender or GORE TAG Conformable Thoracic Stent Graft (W.L. Gore & Associates) between January 1, 2023, and December 31, 2025. RESULTS: Thirteen patients (median age 32 years; range, 21-49 years; 77% male) underwent endovascular treatment. All patients exhibited significant baseline peak-to-peak gradients (median = 23 mm Hg; IQR: 10, 27). Hemodynamic resolution was achieved in all cases (median = 0 mm Hg; IQR: 0, 2; P < .001). Median waist diameter increased from 11 mm (IQR: 9, 12) to 20 mm (IQR: 18, 22) (P < .001). Aortic isthmus ratio increased from 0.46 (IQR: 0.39, 0.54) to 0.87 (IQR: 0.77, 0.92) (P < .001). No intraprocedural complications were observed. CONCLUSIONS: Self-expanding thoracic endografts demonstrated excellent conformability, effective gradient elimination, and early procedural success in the treatment of CoA. Continued follow-up, including protocolized imaging, will be essential to assess mid- and long-term durability and to define the role of this approach in patients with complex aortic anatomy.