Discussion In the cases of stenosis of thoracic or abdominal aorta, its cause can be rarely congenital, and it generates after curing aortitis.3) It also showed up, with Williams syndrome, congenital rubella syndrome, Takayasu’s arteritis, and neurofibroma. Instead of “coarctation”, it is also termed as “middle aortic syndrome” in aorta stenosis generating in lower thoracic or abdominal aorta.4) This patient has not

had a particular infection, and inflammation indexes such as C-reactive protein, fibrinogen, erythrocyte sedimentation rate were within the normal ranges. This Inhibitors,research,lifescience,medical patient didn’t meet the demands of diagnostic criteria of Takayasu’s arteritis except for aortic stenosis. Therefore, we hardly considered Takayasu’s arteritis as a causative disease. Considering refractory hypertension, dyslipidemia and diabetes, we can expect that a localized atherosclerosis gets worse as time goes by. As the

gradient of pressure Inhibitors,research,lifescience,medical between aorta and femoral artery was growing, hypertension might have gotten worse. We may suspect that etiology of congestive heart failure was the thoracic aortic stenosis. And, interestingly, echocardiographic parameter of congestive heart failure such as LVEF and LV dimension were improved only two months after endovascular treatment of the stenosis of aorta dramatically. The treatments of COA are traditional arterectomy with end to end anastomosis, graft Inhibitors,research,lifescience,medical surgery of subclavian artery, percutaneous transluminal angioplasty (PTA), and stent implantation. To minimize the side effects Inhibitors,research,lifescience,medical accompanied by PTA, treatment of COA has used the stent implantation, which can sustain luminal diameter regardless of the degree of intimal damage and reduce recoarctation. There is a recent report that stenting can be considered as a first treatment

modality of COA instead of operation.1),2) It has reported that there were successful cases of stent implantation in stable patients with Inhibitors,research,lifescience,medical COA.5) We also reported the successful case of implantation in a patient with acute left heart failure and acute pulmonary edema with COA. Balloon expandable covered stents are currently being developed that might reduce procedural complications. Instead of a balloon expandable stent, we deployed a self-expandable bare stent. It reduces procedural complications such as dissection and find more rupture of the aorta and needs only a small sized sheath over (12F) with the additional ballooning. It has been reported that there were successful cases of stent implantation in stable patients with COA. Our case showed that the patient’s sign of uncontrolled hypertension and congestive heart failure were remarkably improved after stenting, with no significant adverse cardiac events observed during 4-years of clinical follow-ups. In conclusion, we have reported a rare case of middle aortic stenosis with coronary atherosclerosis and congestive heart failure associated with hypertensive cardiomyopathy.