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

## TL;DR

A patient with a rare spinal artery aneurysm and aortic coarctation was successfully treated with endovascular surgery when open surgery was not feasible.

## Contribution

This case report highlights the use of endovascular treatment for multilevel spinal artery aneurysms in a high-risk patient.

## Key findings

- Endovascular treatment was a viable option for a patient with multiple spinal artery aneurysms and poor surgical candidacy.
- Foramen magnum SAH without a clear source on DSA may require additional imaging like cervical and thoracic myelography.
- The patient showed partial recovery following endovascular treatment.

## Abstract

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.

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.

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.