Treatment algorithm

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups: see disclaimer

ACUTE

critical coarctation

1st line – maintenance of ductal patency

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ACUTE
|
critical coarctation
1st line – 

maintenance of ductal patency

Prostaglandin E1 (alprostadil) maintains patency of the ductus arteriosus in neonates.

Primary options

alprostadil: 0.05 to 0.1 micrograms/kg/minute intravenous infusion initially, adjust gradually according to response, usual maintenance dose 0.01 to 0.4 micrograms/kg/minute

Plus – surgical repair

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ACUTE
|
critical coarctation
Plus – 

surgical repair

Treatment recommended for ALL patients in selected patient group

Surgical repair is the preferred choice in neonates, as it is associated with few repeat interventions.[30]

ONGOING

non-critical coarctationt

1st line – surgical repair

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ONGOING
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non-critical coarctationt
|
≤1 year old
1st line – 

surgical repair

Surgical repair is the preferred choice in neonates, as it is associated with fewer re-interventions than transcatheter repair.[30]

Type of surgical repair depends on length of narrowing and may be an end-to-end anastomosis, arch reconstruction with placement of patch, or bypass graft.

Percutaneous repair is generally not recommended for children <1 year old, as recurrence rates are high. Additionally, stent placement is limited both by patient size and by the rapid growth seen during infancy.

1st line – surgical or percutaneous repair

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ONGOING
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non-critical coarctationt
|
>1 year old
1st line – 

surgical or percutaneous repair

Type of surgical repair depends on length of narrowing and may be an end-to-end anastomosis, arch reconstruction with placement of patch, or bypass graft.

In children and adults with a discrete narrowing, percutaneous angioplasty with or without stent implantation is an appropriate alternative to surgery.[35][36][37] Percutaneous stent implantation has a 98% success rate in repair of aortic coarctation.[38] Some authors have suggested that balloon angioplasty may be superior to surgery, but this remains highly controversial and the level of evidence is poor.[39][40][41] Percutaneous stent implantation may be superior to balloon angioplasty alone, as it has a lower restenosis rate and incidence of aortic wall abnormalities.[42] The overall complication rate of stent implantation is around 12%, including femoral artery access-related complications, aneurysm formation, aortic dissection, and stroke.[38]

Following the placement of artificial materials, such as stents, during interventions for aortic coarctation, it is recommended to prescribe antiplatelet agents (e.g., aspirin) for at least 6 months to prevent thrombotic complications.[15]​

recurrent coarctation

1st line – percutaneous balloon angioplasty or stent placement

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ONGOING
|
recurrent coarctation
1st line – 

percutaneous balloon angioplasty or stent placement

Recurrent coarctation occurs in approximately 10% to 20% of patients.[43] It may be treated with balloon angioplasty or stent placement depending on age and anatomy.

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Choose a patient group to see our recommendations

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups. See disclaimer

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