Background: Coarctation of the aorta (CoA) is a congenital obstructive anomaly that may remain undiagnosed until adulthood, often presenting with systemic hypertension. While percutaneous interventions, including balloon angioplasty and stent implantation, are increasingly utilized in adults, real-world data on procedural outcomes, complications, and long-term mortality remain limited. This study aimed to evaluate procedural outcomes, complication rates, and short- and long-term mortality associated with percutaneous interventions in adult patients with CoA.

Methods: A single-center, retrospective observational study was conducted, including adult patients with CoA who underwent percutaneous intervention between July 2017
and July 2023. Procedural success was defined as a residual peak systolic gradient ≤20 mmHg without major complications. Patient demographics, comorbidities, procedural details, complications, and follow-up outcomes were analyzed.

Results: Twenty-nine patients (median age 40 [29-45] years; 31% female) were included. Endovascular stent placement was performed in 89.7% of patients, 74% of whom were covered stents (mean length 39 mm). Balloon angioplasty alone was used in 10.3% of cases. The procedure was associated with a marked reduction in the peak systolic gradient, decreasing from a median of 57.5 mmHg [50.0-68.8] before the procedure to 9.0 mmHg [1.2-11.8] after the procedure. Complications occurred in 6.9%, including 1 aortic rupture and 1 access site bleeding. Recoarctation developed in 14% of patients at a median of 17.5 months. No in-hospital deaths occurred; out-of-hospital mortality was 6.9%, including 1 death of unknown cause and 1 following posterior mediastinal hematoma after aortic rupture.

Conclusions: Percutaneous interventions in adult CoA achieve favorable procedural success and low in-hospital mortality, while rare but serious complications underscore the necessity for meticulous management and lifelong follow-up.