• Zhi-Liang Zuo, Jia-Yu Tsauo, Mao Chen, and Yuan Feng.
• Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
• Medicine (Baltimore). 2017 Mar 1; 96 (10): e6089.

RationaleIsolated dismal transverse aortic arch kinking in adults is rare, and there is no recommended therapy at present. Percutaneous stent implantation may be an effective method to correct it and could be considered.Patient ConcernsWe report a 46-year-old woman who suffered from recurrent migraine and refractory hypertension with a significant systolic blood pressure difference between upper limbs.DiagnosesThe woman was diagnosed with isolated dismal transverse aortic arch kinking with refractory hypertension.InterventionsPercutaneous stent implantation was performed. Due to the kinking nature of the diseased transverse aortic arch, the first covered stent moved forward to the proximal transverse aortic arch during deploying without the left common carotid artery occlusion. And then, a second stent was placed to cover the residual kinked part of the dismal transverse arch.OutcomesAngiography and post-procedural computed tomography angiography revealed fully corrected of the diseased segment. At 6-month follow-up after procedure, the patient was free of any symptoms and had a normal blood pressure under antihypertensive treatment.LessonsThis case indicates that transverse aortic arch kinking in isolation can be well treated by percutaneous stent implantation in adult patients. Unlike pure aortic coarctation, elongation and bucking give the rise to the occurrence rate of stent sliding and migration and sometimes a second stent is needed.

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