Tailored hybrid treatment of adult aortic re-coarctation using a custom thoracic endograft with balloon-expandable stent reinforcement.

We report a 40-year-old man (167 cm, 69 kg) with a complex surgical history, including repaired coarctation of the aorta and a Bentall procedure with mechanical valve replacement, who presented with recurrent, haemodynamically significant coarctation of the aorta, severe arterial hypertension, and a challenging 17 mm diameter mismatch between the aortic arch and descending aorta. As surgery was declined, a tailored hybrid solution was adopted: deployment of a custom thoracic endograft to bridge the calibre transition, reinforced with a balloon-expandable stent to optimise luminal gain. The approach achieved complete gradient resolution without complications, allowing for discharge at 48 hours. This case underscores the feasibility of personalised hybrid repair for complex re-coarctation of the aorta.