Coarctation of the Aorta Treatment Guidelines

Indications for Intervention

The European Society of Cardiology recommends intervention for coarctation of the aorta when hypertension (>140/90 mmHg in adults) and a non-invasive arm-to-leg gradient >20 mmHg are present, with preference for stenting when technically feasible 1
The European Society of Cardiology suggests that hypertensive patients with >50% aortic narrowing relative to the diameter at the diaphragm level should be considered for endovascular treatment even if the invasive gradient is <20 mmHg 1
Normotensive patients with invasive peak-to-peak gradient >20 mmHg should be considered for endovascular treatment when technically feasible 1

For older children (>25 kg) and adults, the European Society of Cardiology recommends transcatheter treatment with covered stent placement as the first-choice treatment 1
The American College of Cardiology suggests that balloon angioplasty without stenting may be considered if stent placement is not feasible and surgical intervention is not an option, though it carries higher recurrence rates and risk of aneurysm formation 4

The European Society of Cardiology recommends obtaining blood pressure measurements in both arms and one lower extremity to document gradients 1, 4
The European Society of Cardiology suggests that CMR or cardiac CT should be used to visualize the entire thoracic aorta, define the coarctation anatomy, assess for arch hypoplasia, identify collateral vessels, and detect aneurysms 1, 2, 4
Invasive catheterization with manometry remains the gold standard for confirming hemodynamic significance (peak-to-peak gradient >20 mmHg) before intervention 5

The European Society of Cardiology recommends that all coarctation patients require lifelong follow-up regardless of treatment success, with CMR or cardiac CT every 3-5 years to monitor for re-coarctation, aneurysms, pseudoaneurysms, and dissection 1, 4
The American College of Cardiology suggests that 24-hour ambulatory blood pressure monitoring or exercise testing better detects hypertension than office measurements alone 1, 4
The European Society of Cardiology recommends treating hypertension according to standard hypertension guidelines 1

The European Society of Cardiology recommends surveillance for bicuspid aortic valve dysfunction and ascending aortic dilation in patients with coarctation of the aorta 1, 6
The American College of Cardiology suggests that screening for intracranial aneurysms by MRA or CTA may be reasonable, though routine screening in asymptomatic patients is not currently evidence-based 1, 4