Ruptured spinal artery aneurysm associated with coarctation of the aorta

Background: Spinal artery aneurysms associated with aortic coarctation are exceptionally rare, with only eight cases reported in the literature that we are aware of, and treatment of the aneurysm described only in one of them. Aortic coarctation often results in an aberrant collateral circulation with hyperdynamic flow and potential spinal artery aneurysm formation, growth, and rupture. Microsurgical, interventional, and medical management of these lesions can be challenging and has rarely been reported. Complication avoidance requires thorough knowledge of the clinical presentation of the disease, the hemodynamic factors involved, and the therapeutic tools available.

Case description: A 59-year-old woman with a previously undiagnosed isthmic coarctation of the aorta presented with subarachnoid hemorrhage. A 7-mm wide-necked, saccular spinal artery aneurysm was identified as the source of the hemorrhage and was subsequently successfully coiled through a transbrachial access route. After rehabilitation, the patient returned to her asymptomatic neurologic baseline, and underwent successful surgical repair of the aortic coarctation with placement of an interposition graft.

Conclusions: Spinal artery aneurysms induced by aortic coarctation are rare and complex entities. They pose unique surgical and medical challenges. Securing the aneurysm should be prioritized specifically in cases of subarachnoid hemorrhage. Blood pressure should be closely monitored and balanced to reduce the risk of rehemorrhage and at the same time allow for sufficient end-organ perfusion.