BACKGROUND: We implanted covered CP stents as a rescue treatment in patients with CoA aneurysms in patients with previous history of surgical or trans catheter COA repair, patients with COA&PDA and systemic PH , patients with dissection of aorta while catheterization and in patients at risk of developing complications such as complex CoA anatomy near-aortic arch interruption . This study sought to evaluate the use of covered stents in the treatment of complex COA specially in children and young patients. METHODS: Fifteen covered CP stents were implanted in 13 patients,6 patients had had previous history of surgery COA repair or balloon angioplasty, 3 patients had complex or near-atretic CoA,3 patients with COA&LargePDA with systemic PH,1 patient with dissection while catheterization. Cheatham-platinum stents covered with expanded polytetrafluoroethylene were used in all patients (NuMED Inc). The maximum balloon diameter was chosen based on either the transverse or the distal arch diameter, whichever was greater, and on occasions 1 to 2 mm greater. The stent was crimped onto a BIB balloon (NuMED Inc). Rapid right ventricular pacing was used during stent deployment in all cases. Heparin at a dose of 75- 100 IU/kg was given . Heparin infusion or subcutaneous low-molecular-weight heparin was administered for a total of 24 h. Antibiotics were given at the beginning of the procedure and continued for 24 h. Aspirin was administered to all patients after the procedure at a dose of 3 to 5 mg/kg and continued for 6 months with clopidogrel 1mg/kg for at least 1 month. RESULTS: The mean patient age and weight were 14±6 years (range 7 to 24 years), and 32± 9kg (range 19 to 64 kg), respectively. The systolic gradient across the CoA decreased from a mean (±SD) of 32 ± 15 mm Hg before to a mean of 8 ± 4 mm Hg after the procedure (p < 0.001), and the diameter of the CoA increased from 4 ± 3.5 mm to 16 ± 2 mm (p < 0.001) A successful outcome was defined as a peak systolic pressure gradient after stent implantation of <20 mm Hg. The follow-up period was up to24 months (mean, 12 months). All stents were patent and in good position on Echocardiography, angiogram or computed tomography. CONCLUSIONS: Covered CP stents may be used as the therapy of choice in patients with complex CoA . In the light of our experience and published data, we believe that covered CP stents are very useful tools for treating various congenital malformations. In particular, they would seem to be indicated in the following clinical settings: (I) subatretic native aortic coarctation (II) severe aortic coarctation or recoarctation (III) native aortic coarctation or recoartation with aneurysm (IV) aortic coarctation and patent ductus arteriosus (V) collateral vessels creating left to right shunting and (VI) bail-out in cases of complications in the catheterization laboratory. There are, however, few reports on the use of covered stents in congenital heart diseases , a setting in which their role remains to be clearly defined.