Surgery is the best treatment for primary coarctation in the majority of cases.

Today, the availability of competing techniques for coarctation repair, including numerous surgical approaches as well as interventional ones, raises important questions about indications, risks and criteria for procedural success. Surgical treatment of coarctation is an extremely well tolerated procedure with excellent long-term efficacy due to an 88 to 96% 5 years freedom from re-intervention in patients operated on within the first months of life. If compared with surgery, balloon angioplasty features a higher risk for aneurysm formation, aortic rupture and a lower degree of success, with potentially important residual pressure gradient in up to 20.7% of patients. Stents are believed to overcome the problems of simple dilation, but concerns remain about the materials and the potential of re-expandibility in view of the growth of the treated aorta. Moreover, serious complications, including death, have been reported by stent implantation as well, similar to aneurysms or dissections (4.3%), balloon rupture with stent migration or cerebral vascular injury (9%). There is no evidence to date for the superiority of any interventional approach to surgical treatment of primary coarctation. The favorable long-term surgical results outweigh the proposed short-term benefits of angioplasty and stenting, which should be restricted to well selected cases.