Proximal stent migration during coarctation of aorta stenting.

Background: Transcatheter stenting has become the preferred treatment for native and recurrent coarctation of aorta (CoA), but complications such as stent migration occur in approximately 5% of cases. Proximal stent migration is particularly challenging and often requires surgical intervention. This report highlights the successful transcatheter management of proximal stent migration during CoA stenting in a high-risk patient.

Case Presentation: A 22-year-old woman with Turner syndrome and chronic idiopathic thrombocytopenia purpura (ITP) presented with severe native CoA and refractory hypertension. Echocardiography revealed severe left ventricular hypertrophy and bicuspid aortic valve with mild aortic stenosis. The CoA segment gradient was 90 mmHg. During stent implantation using a 16 × 44 mm Zephyr stent mounted on an Atlas balloon, the stent migrated proximally into the right brachiocephalic artery despite appropriate crimping and hypotensive pacing. The stent was stabilized using a pigtail catheter via the right radial artery, and a low-profile peripheral balloon was inflated distal to the stent to pull the system back. However, the stent became stuck at the tightest segment of the CoA. Predilation of the CoA site with a larger balloon widened the segment, allowing the stent to be repositioned and deployed successfully. Post-procedure, the gradient across the CoA decreased to less than 5 mmHg. The patient was discharged after two days without complications, and follow-up imaging confirmed proper stent placement without restenosis.

Conclusions: Our case illustrates the transcatheter management of proximal stent migration during CoA stenting, potentially reducing the need for surgical intervention. A stepwise strategy involving stent stabilization, low-profile balloon-assisted repositioning, and predilation of tight CoA segments can facilitate successful stent repositioning. This case contributes to the existing literature by documenting the occurrence and management of this rare complication.