Transcatheter stent implantation for long-segment coarctation in a young child: technical considerations and vascular safety using a large-diameter covered stent a case report.

BACKGROUND

Severe long-segment coarctation of the aorta in children is traditionally managed surgically; however, transcatheter stent implantation is emerging as a viable alternative in selected cases. The use of large-diameter covered stents in small children raises concerns regarding vascular access, procedural safety, and future reintervention. CASE PRESENTATION: An 8-year-old male child (21.7 kg) with global developmental delay presented with breathlessness. Clinical examination revealed radio-femoral delay, absent lower limb pulses, and upper limb hypertension (130/80 mmHg). Echocardiography demonstrated severe coarctation with left ventricular hypertrophy. CT aortography confirmed long-segment narrowing involving the aortic isthmus and proximal descending thoracic aorta, with a minimum diameter of 2.2 mm and a proximal descending aortic diameter of 12.3 mm. Cardiac catheterization showed an 80 mmHg peak systolic gradient. A transcatheter approach was undertaken. Right femoral arterial access was obtained using stepwise dilatation to accommodate a 12 Fr sheath. After systemic anticoagulation, a Zephyr XL covered stent (ZPXL 34) was deployed across the lesion under fluoroscopic guidance. Controlled expansion was performed, and mild residual narrowing was intentionally accepted to reduce the risk of aortic injury and allow staged dilatation. The post-procedural gradient decreased to 15 mmHg. Angiography confirmed satisfactory stent position with preserved left subclavian artery flow, and Doppler assessment showed no vascular complications. Lower limb pulses improved immediately.

CONCLUSION

Transcatheter implantation of a large-diameter covered stent can be performed safely in selected young children with long-segment coarctation when meticulous attention is given to vascular access, device selection, and controlled, staged dilatation strategies.