Endovascular treatment of congenital descending aorta coarctation complicated by multiple tandem spinal artery aneurysms: a case report and literature review.

BACKGROUND: Spinal artery aneurysms are a rare type of aneurysm, and their diagnosis and treatment are challenging. In this case report, we describe a patient in whom congenital descending aorta coarctation was complicated by subarachnoid hemorrhage secondary to the rupture of a multilevel spinal artery aneurysm, which was treated with endovascular surgery.

CASE DESCRIPTION: A 54-year-old man presented with head and neck pain, nausea, and vomiting. He had congenital descending aorta coarctation, which was untreated. Imaging was notable for subarachnoid hemorrhage (SAH) (Modified Fisher grade 3), severe congenital descending aorta coarctation, and multiple aneurysms of the anterior spinal artery and left middle cerebral artery (MCA). One month after external ventricular drainage (EVD) and lumbar drainage (LD), his clinical status gradually stabilized. Owing to the poor general condition and the presence of multiple aneurysms, open surgery was deemed unsuitable, and endovascular treatment was performed. The patient had achieved partial recovery at the15 days operative follow-up.

CONCLUSION: This case indicates that foramen magnum SAH with no identifiable source on conventional DSA warrants further investigation via cervical and thoracic myelography, CTA or MRI. Endovascular treatment may be considered for patients with multilevel spinal artery aneurysms and poor surgical candidacy due to frailty.