The natural history of type B aortic coarctation differs from that of type A aortic coarctation, and its prognosis is relatively good, with a lower likelihood of acute aortic dissection, pericardial tamponade, and other emergencies. However, type B aortic coarctation is associated with an older age, and patients tend to have a combination of hypertension, atherosclerosis, and diabetes, so their in-hospital mortality rate is not low. An International Investigation of Acute Aortic Dissection (IRAD) showed that the in-hospital mortality rate for patients with acute Stanford type B dissection was approximately 12.8%. The current Stanford staging, DeBakey staging, and Crawford staging methods for descending aortic coarctation and aneurysmal lesions have shortcomings, they are relatively crude, and with the continuous development of science and technology, the emergence of various new materials such as new overlapping stent vessels, and the continuous improvement of extracorporeal circulation technology, it is necessary to rethink the staging method with new concepts and new perspectives. With the continuous development of science and technology, the emergence of various new materials such as new clad stent vessels, and the continuous improvement of extracorporeal circulation technology, it is necessary to revisit Stanford type B entrapment with new concepts and new eyes. The author proposes a refined staging method for Stanford B aortic coarctation based on many years of treatment experience and recent advances in treatment. Refinement of treatment strategies for Stanford type B coarctation Because the early mortality rate for surgical treatment of Stanford type B coarctation is about 32.1%, while the early mortality rate for conservative medical treatment is about 9.6%, there has been a long-standing preference for conservative medical treatment of type B aortic coarctation. However, the long-term outcome of conservative medical treatment is less satisfactory. Elefteriades et al. reported that approximately 9% of patients with acute type B coarctation died during hospitalization, and 66% of the remaining patients required surgical treatment later. Chronic type B aortic coarctation can occur not only in patients with type B coarctation, but also secondary to previous surgical treatment for type A coarctation, so that most chronic type B coarctations regress to aneurysm. Even with strict pharmacological treatment, 30-40% of patients will still develop aneurysmal dilatation within 10 years. One study (50 patients, 40 months of observation) showed that approximately 18% of patients died from entrapment rupture during the observation period, and an additional 20% of patients underwent surgery for symptomatic entrapment neoplasia. By refining the staging of Stanford type B entrapment, more appropriate treatment options can be selected for different types of patients. Since 1994, when Dake et al. pioneered the use of overlapping stents in the treatment of thoracic aortic aneurysms and descending aortic coarctation, there have been no large randomized controlled clinical trials to confirm the long-term results of overlapping stent placement versus conservative treatment, but there is a growing trend for clinicians to aggressive treatment of type B entrapment. Giovanni et al. reported a high rate of pseudoluminal thrombosis (75% vs. 10.7%, P=0.0001) and a low rate of neoplasia (3.5% vs. 28.5%, P=0.02) in cases of acute type B entrapment treated with intervention. According to recent data, interventional treatment may be more effective than conservative treatment and surgical treatment alone, but the key is to strictly grasp the indications for treatment. In clinical work, the author also encountered more patients who required surgical treatment due to poor selection of surgical indications, resulting in proximal aortic coarctation after stent placement. Therefore, the author believes that overlapping stent placement is only applicable to patients with B1S type aortic coarctation. Aggressive surgical treatment Patients with type B2, B3, and C aortic coarctation (not suitable for overmolded stent placement) should receive surgical treatment Type B1C coarctation Partial thoracic descending aortic replacement or partial thoracic descending aortic replacement + distal stent placement is an option for these cases. In some patients, a left subclavian artery can be bypassed with the ascending aorta by placing a self-expanding stent vessel between the left common carotid artery and the left subclavian artery using a median open chest. Type B2 entrapment Partial thoracic descending aorta + distal angioplasty is indicated for patients with chronic entrapment. If the patient has poor vessel wall quality, total thoracic aortic replacement should be performed. Type B3 entrapment Total thoracoabdominal aortic replacement should be performed in these cases. This procedure is difficult and requires a high level of operator and extracorporeal circulation, so it should be performed in an experienced cardiovascular center. Insights and explorations 1. The refined staging of Stanford type B coarctation helps to select the correct treatment plan, improve the treatment outcome and reduce the reoperation rate. 2, After the diagnosis of type B aortic coarctation is confirmed, it should still be treated with more aggressive interventions. 3.There is still a big controversy about the timing and indications for treatment of B-type aortic coarctation. We hope that domestic units that are qualified to treat aortic coarctation can cooperate and conduct multicenter randomized controlled clinical studies. And we believe that with the progress of materials, science and related technology, the diagnosis and treatment level of aortic coarctation will be greatly improved.