title: Ruptured spinal artery aneurysm associated with coarctation of the aorta.
abstract: 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.
  
  
  METHODS
  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.
authors.affiliation: Department of Neurological Surgery, Feinberg School of Medicine and McGaw Medical Center, Northwestern University, Chicago, Illinois, USA.
authors.forename: Salah G
authors.initials: SG
authors.lastname: Aoun
authors.affiliation: Department of Neurological Surgery, Feinberg School of Medicine and McGaw Medical Center, Northwestern University, Chicago, Illinois, USA.
authors.forename: Tarek Y
authors.initials: TY
authors.lastname: El Ahmadieh
authors.affiliation: Department of Radiology, Feinberg School of Medicine and McGaw Medical Center, Northwestern University, Chicago, Illinois, USA.
authors.forename: Maryam
authors.initials: M
authors.lastname: Soltanolkotabi
authors.affiliation: Department of Radiology, Feinberg School of Medicine and McGaw Medical Center, Northwestern University, Chicago, Illinois, USA.
authors.forename: Sameer A
authors.initials: SA
authors.lastname: Ansari
authors.affiliation: Department of Interventional Radiology, Alexian Brothers Medical Center, Elk Grove Village, Illinois, USA.
authors.forename: Franklin A
authors.initials: FA
authors.lastname: Marden
authors.affiliation: Department of Neurological Surgery, Feinberg School of Medicine and McGaw Medical Center, Northwestern University, Chicago, Illinois, USA.
authors.forename: H Hunt
authors.initials: HH
authors.lastname: Batjer
authors.affiliation: Department of Neurological Surgery, Feinberg School of Medicine and McGaw Medical Center, Northwestern University, Chicago, Illinois, USA; Department of Radiology, Feinberg School of Medicine and McGaw Medical Center, Northwestern University, Chicago, Illinois, USA. Electronic address: bbendok@nmff.org.
authors.forename: Bernard R
authors.initials: BR
authors.lastname: Bendok
mesh_terms: D017542:Aneurysm, Ruptured / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy*; D000792:Angiography; D001017:Aortic Coarctation / Q000150:complications* / Q000000981:diagnostic imaging; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D008875:Middle Aged; D013116:Spinal Cord / Q000098:blood supply*; D014057:Tomography, X-Ray Computed