Coarctation of the aorta can be diagnosed across a wide age spectrum and with a range of symptoms. An untreated coarctation of the aorta presenting later in life has a negative impact on long-term survival, as compared with patients diagnosed and treated in early life [
8]. Late complications such as aortic aneurysm formation, infective endocarditis, hypertension, premature (coronary) atherosclerosis and cerebrovascular accidents all account for the increased morbidity and mortality [
9,
10]. The two patients described above were both diagnosed in adulthood. Traditionally, surgical repair has been an effective treatment option for adult patients with native coarctation, and it has been shown to improve the efficacy of postoperative antihypertensive treatment. Adult patients with native coarctation are usually at lower operative risk than re-coarctation patients because there are no concerns related to pleural or peri-aortic scar tissue associated with previous surgical repair. However, these patients do have many associated cardiovascular comorbidities including left ventricular hypertrophy and arrhythmias [
8]. The first case presented with a severe aortic coarctation, with many collaterals due to the severe obstruction. In the second case the severe aortic coarctation was accompanied by a hypoplastic arch and an impaired left ventricular function possibly due to long-lasting alcohol abuse. In both cases, the risk of cardiac surgery was estimated to be too high. In case 1, the extensive collateral network surrounding the coarctation caused a substantial risk of peri-operative bleeding complications. In case 2 surgical risk was increased because of the impaired left ventricular function. In both cases endovascular repair with balloon angioplasty and stent placement was performed. Endovascular repair with or without stenting has been demonstrated to be an acceptable alternative to surgical repair with similar outcome in native coarctation. The use of covered stents has been promoted to avoid vascular complications [
8]. The incidence of recoarctation after stent placement is lower than after balloon angioplasty alone, due to a lower degree of elastic recoil and avoidance of vessel overdilation and, as a consequence, reduced aortic injury. Concerns that arise in coarctation patients after endovascular repair are strut fractures, metal fatigue or aortic deterioration or aortic disruption at the coarctation site [
11]. However, studies documenting the long-term outcomes of stent implantation confirmed the low rate of procedure-related adverse events and a long-term procedural success in both native and recurrent aortic coarctation or aneurysmal disease [
12,
13]. Long-term outcome was comparable with other surgical and interventional modalities. This case report demonstrates the variety of indications in which percutaneous treatment is preferable to surgical treatment in adult patients with native aortic coarctation. More research on the long-term assessment of adult native coarctation patients after percutaneous intervention will be important to determine the impact on survival in these patients.