BACKGROUND: Middle aortic syndrome (MAS) is a clinical condition generated by segmental narrowing of the abdominal or distal descending thoracic aorta. Endovascular treatment has gained acceptance as a modality of treatment for MAS. In this study we report our preliminary results and long-term follow-up of stent implantation for MAS. METHODS: Five patients [(2 male, mean: 45짹15yrs (22-65)] with severe hypertension or claudication secondary to middle aortic coarctation were studied with aortograms and subsequently treated by endovascular treatment. RESULTS: At the time of stent implantation, the systolic pressure gradient decreased from a mean of 76짹17 (55-100) to 17짹5mmHg (p < 0.001). The coarctation diameter increased from a mean of 7.9짹1.2 to 16.8짹1.3 mm (p < 0.001). Lesion location of aorta was only thorac aorta (T8-T11 level in 4 patients) in all patients. Stent diameter and size were mean 21.0짹2.5mm (18-24) and 80짹28mm (40-100). Final adjunctive balloon diameter was 13짹1mm (12-14). The patients have been followed for 6짹4 years (37-91 months) with no complications. The stents remain in position with no fracture. No other intervention has been required. The systolic gradient at latest follow-up is 2.8짹0.4mmHg. Only one (a 65-year old with diabetes and long-standing hypertension) of five patients previously requiring antihypertensive treatment still remain on medications for blood pressure control. CONCLUSIONS: The use of stents in MAS is a feasible alternative to surgical repair in selected patients. Long-term follow-up shows excellent gradient relief, with no complications in this group of patients.