Tailored strategies for recurrent aortic coarctation in a pediatric patient with Pascual-Castroviejo type II syndrome and Moyamoya Syndrome.

Transcatheter or surgical treatment of coarctation of the aorta (CoA) and recoarctation is the gold standard in adults and children. However, in some cases, both approaches are challenging and require a tailored strategy. A female child affected by Moyamoya and PHACE syndrome presented with a diagnosis of CoA with significant posterior arch hypoplasia. At 3 years of age, she underwent surgical aortic arch reconstruction. Nine months after the procedure, the patient developed a significant recoarctation and underwent an unsuccessful percutaneous aortic angioplasty. The recoarctation was treated with a Valeo® balloon-expandable vascular stent. At 8 years of age, the patient developed restenosis due to multiple stent fractures. The implantation of the covered stent was postponed, since the femoral artery could not accept an appropriately sized sheath. A conservative medical strategy was adopted. At 14 years, the femoral artery diameter was adequate, and a covered Cheatham Platinum stent (39 mm) was crimped onto a semi-compliant balloon (16 mm) and implanted. This case emphasizes the critical need for highly personalized strategies in managing CoA and recoarctation in children.