title: Stenting across head and neck vessels using covered stents for persisting aortic arch obstruction.
abstract: OBJECTIVE
  To describe endovascular stent placement using partially covered stents to preserve flow in head and neck vessels.
  
  
  BACKGROUND
  Endovascular stent placement has become established as a first-line therapy for native coarctation of the aorta or re-coarctation in older children and adults. Increasingly covered stents are becoming the preferred option over bare-metal stents because of the perceived lower risk of aneurysm formation. Open-cell bare-metal stents are chosen when there is a high likelihood of jailing a head and neck vessel. Here we describe partial uncovering of a covered stent before implantation to allow flow through the uncovered portion of the stent to the branch vessel but preserve the covering over the majority of the remaining stent.
  
  
  METHODS
  We describe two cases with aortic arch hypoplasia and re-coarctation, both of which required two partially uncovered stents for a satisfactory result.
  
  
  CONCLUSIONS
  Endovascular stent placement is becoming the preferred option in the management of coarctation of the aorta in older children and adults. Strategies to deal with transverse arch hypoplasia and multiple levels of aortic arch obstruction frequently involving branch vessels or aneurysms need to be considered before these procedures are embarked upon. Partially uncovering stents may afford more protection than using bare-metal stents in the transverse and distal arch while preserving flow in head and neck branches, and is a technically straightforward procedure.
authors.affiliation: Department of Paediatric Cardiology, Great Ormond Street Hospital, London, United Kingdom.
authors.forename: James R
authors.initials: JR
authors.lastname: Bentham
authors.forename: Nilesh
authors.initials: N
authors.lastname: Oswal
authors.forename: Robert
authors.initials: R
authors.lastname: Yates
mesh_terms: D000293:Adolescent; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D001017:Aortic Coarctation / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography; D001807:Blood Vessel Prosthesis; D002648:Child; D057510:Endovascular Procedures / Q000379:methods*; D005500:Follow-Up Studies; D006257:Head / Q000098:blood supply*; D006801:Humans; D008297:Male; D009333:Neck / Q000098:blood supply*; D011474:Prosthesis Design; D015607:Stents