Coarctation accounts for 5–8% of congenital cardiovascular defects and confers premature death, stroke, left ventricular hypertrophy, heart failure and/or bleeding collateral neovessels. With the therapeutic consensus that any trans-coarctation gradient needs to be abolished to improve outcomes the classic management of surgical repair is being replaced by less traumatic endovascular interventions to achieve similar results at a markedly lower risk; surgical trauma and bleeding complication can be essentially avoided with the advent of suitable balloon-inflatable stents and stent grafts, as well as with self-expanding stents. This changing paradigm towards nonsurgical endovascular management is supported by improved outcome and lower morbidity with sustained control of systemic blood pressure. Both the need for continued and individualized medication and the occasional reoccurrence of a gradient warrant a life-long surveillance of any patient with adult coarctation.