Ruptured Spinal Artery Aneurysm Associated with Coarctation of the Aorta

Aoun, Salah G.; Ahmadieh, Tarek Y. El; Soltanolkotabi, Maryam; Ansari, Sameer A.; Marden, Franklin A.; Batjer, H. Hunt; Bendok, Bernard R.

doi:10.1016/j.wneu.2012.07.027

Cited by 18 publications

(5 citation statements)

References 22 publications

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“…In those patients with coarctation of the aorta, it can be difficult to access the spinal vessels via the femoral arteries and the brachial artery may need to be cannulated. 4 There may be significant technical difficulty in catheterizing the small spinal vessels that have lower flow rates than the cranial vessels, and surgery may be the best option in such a situation. 2,45,81 The other issue arises when the aneurysmal sac is very large in size.…”

Section: Therapymentioning

confidence: 99%

“…4,7,9,10,13 They are probably more common in women and most present with hemorrhage. 4,16,80 The ideal management technique (surgical clipping/excision or endovascular) and the outcome with respect to clinical recovery and SA obliteration rates have not been established. Most descriptions of SAs in the literature are reports of single cases and only a few case series have been published.…”

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confidence: 99%

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Spinal aneurysms: clinicoradiological features and management paradigms

Madhugiri

Ambekar

Kumar

et al. 2013

SPI

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Object Spinal aneurysms (SAs) are rare lesions. The clinicoradiological features and the exact degree of their association with comorbid conditions such as arteriovenous malformations (AVMs) and coarctation of the aorta have not been definitively described. The ideal management paradigm has not been established. The authors reviewed literature to determine the clinical patterns of presentation, management, and outcome of spinal aneurysms. Methods A systematic review of literature was performed using 23 separate strings. A total of 10,190 papers were screened to identify 87 papers that met the inclusion criteria. A total of 123 SAs could be included for analysis. Results The mean age of patients at presentation was 38 years; 10% of patients were aged less than 10 years and nearly 50% were greater than 38 years. Spinal aneurysms can be divided into 2 groups: those associated with AVMs (SA-AVMs, or Type 1 SAs) and those with isolated aneurysms (iSAs, or Type 2 SAs). Patients with Type 2 SAs were older and more likely to present with bleeding than those with Type 1 SAs. The acute syndromes can be divided into 3 groups of patients: those with spinal syndrome, those with cranial/craniospinal syndrome, and those with nonspecific presentation. Overall, 32.6% presented with angiography-negative cranial subarachnoid hemorrhage (SAH). Presentation with evidence of cord dysfunction (myelopathy/weakness/sensory loss/bladder involvement) correlated with poor outcome, as did presentation with hemorrhage and association with other comorbid conditions. Surgery and endovascular therapy both led to comparable rates of complete aneurysm obliteration for Type 2 SAs, whereas for the AVM-associated Type 1 SAs, surgery led to better rates of lesion obliteration. The authors propose a classification scheme for spinal aneurysms based on whether the lesion is solitary or is associated with a coexistent spinal AVM; this would also imply that the ideal therapy for the aneurysm would differ based on this association. Conclusions The clinical and radiological patterns that influence outcome are distinct for Type 1 and Type 2 SAs. The ideal treatment for Type 1 SAs appears to be excision, whereas surgery and endovascular therapy were equally effective for Type 2 SAs.

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Section: Therapymentioning

confidence: 99%

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confidence: 99%

Spinal aneurysms: clinicoradiological features and management paradigms

Madhugiri

Ambekar

Kumar

et al. 2013

SPI

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“…One such case has been described by Aoun et al., where the diagnosis was confirmed by CT angiography and subsequently the patient underwent therapeutic embolization. 11 In two of our cases, the diagnosis of the ASA aneurysm was made on CT angiography and in the third case, there was suspicion of ASA aneurysm on MRI that was subsequently confirmed on DSA. Although DSA is the gold standard for diagnosis and treatment planning, with the advancement of CT angiographic technique, wider availability and greater area of coverage, it has now become a useful noninvasive modality for initial diagnosis of these aneurysms.…”

Section: Discussionmentioning

confidence: 61%

Anterior spinal artery aneurysm in aortic stenosis of different etiology: Report of three cases

et al. 2017

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Isolated aneurysms of spinal arteries are rare. Spinal artery aneurysms are commonly found in association with spinal cord arteriovenous malformation and coarctation of aorta and rarely with aortic arch interruption and Klippel-Trenaunay syndrome. Spinal angiograms are the gold standard for diagnosing these spinal artery aneurysms but with the advances in computed tomography technology these aneurysms can also be very well demonstrated in computed tomography angiograms. We describe three cases of anterior spinal artery aneurysm, those are flow related aneurysms, associated with coarctation of aorta and with Takayasu arteritis.

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“…Several case reports demonstrate that, for instance, spinal and intercostal artery aneurysms are at risk for rupture, potentially with fatal outcomes ( 44 ). However, current guidelines fail to address the management of these aneurysms ( 45 – 47 ). Therefore, the treatment strategy was determined by the expert opinion of the multidisciplinary adult congenital heart disease team.…”

Section: Discussionmentioning

confidence: 99%

A percutaneous treatment strategy of an adult patient with a bicuspid aortic valve, coarctation of the aorta, and an exceptionally large aneurysm of a collateral artery: Case report and literature overview

Verheijen

Stöger

Kley

et al. 2022

Front. Cardiovasc. Med.

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Coarctation of the aorta (CoA) is a congenital heart defect that is associated with a bicuspid aortic valve (BAV), ascending aorta dilatation, intracerebral aneurysms, and premature atherosclerotic disease. The first presentation during late adulthood is rare and is frequently driven by late sequelae. Hypertrophic collateral arteries can develop aneurysms which are at risk for spontaneous rupture, however, treatment recommendations for these aneurysms are scarce. Here, we describe the clinical course and percutaneous treatment strategy of a patient with a late diagnosis of a pin-point CoA, a BAV with moderate regurgitation, and an exceptionally large aneurysm of a collateral artery. A 59-year-old woman was diagnosed with Streptococcus bovis endocarditis of a BAV with moderate aortic valve regurgitation and small vegetation (<5 mm) on the non-coronary cusp. Work-up revealed hypertension and adenocarcinoma in situ of the ascending colon, considered the bacteremia porte d’entrée, for which a curative hemicolectomy was performed. Echocardiography showed a narrowing of the aorta distal from the origin of the left subclavian artery with the antegrade diastolic flow with a pathognomonic “sawtooth” pattern and an estimated pressure gradient of >70 mmHg. Computed tomography angiography (CTA) showed a network of well-developed collateral arteries and a levoatriocardinal vein. One of the collateral arteries arising from the left subclavian artery revealed an exceptionally large aneurysmatic dilation (29 × 24 × 24 mm). The invasive assessment confirmed a hemodynamically significant CoA. Treatment involved balloon dilatation and placement of a covered stent at the site of the pin-point CoA and a percutaneous coronary intervention (PCI) of the stenosis in the left anterior descending artery. No residual gradient over the CoA was observed. Antihypertensive drugs could be discontinued, and CTA performed 4 months later showed regression and thrombosis of the numerous collaterals and, importantly, thrombosis of the large aneurysm. This case illustrates the late diagnosis of CoA with associated congenital heart defects and late sequelae including hypertension, BAV endocarditis, coronary artery disease, and aneurysm formation of the extensive collateral network. The patient underwent pharmacological and percutaneous treatment, ultimately resulting in the alleviation of the CoA, normalization of the blood pressure, reduction of collateral flow, and thrombosis of the large aneurysm of the collateral artery.

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Ruptured Spinal Artery Aneurysm Associated with Coarctation of the Aorta

Cited by 18 publications

References 22 publications

Spinal aneurysms: clinicoradiological features and management paradigms

Spinal aneurysms: clinicoradiological features and management paradigms

Anterior spinal artery aneurysm in aortic stenosis of different etiology: Report of three cases

A percutaneous treatment strategy of an adult patient with a bicuspid aortic valve, coarctation of the aorta, and an exceptionally large aneurysm of a collateral artery: Case report and literature overview

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