Anterior Spinal Artery Aneurysms Associated with Coarctation of the Aorta: A Focused Narrative Review with an Illustrative Case

Anterior spinal artery (ASA) aneurysms are rare causes of subarachnoid hemorrhage (SAH), and coarctation of the aorta (CoA) may recruit the spinal arterial circulation into a high-flow collateral network. We report the case of a 58-year-old woman who was resuscitated after pulseless electrical activity arrest. Noncontrast CT demonstrated SAH concentrated in the cervical spinal canal with limited intracranial extension. Cervically extended CT angiography identified a C5-6 ventral spinal aneurysm, severe thoracic CoA with extensive collateralization, and diffuse left subclavian artery hypoplasia. Digital subtraction angiography confirmed the presence of a multilobulated sidewall ASA aneurysm supplied by an artery of the cervical enlargement arising directly from the subclavian artery. Selective coil embolization achieved complete aneurysm occlusion with preservation of the parent artery; this was followed by C5-6 laminectomy and posterior arthrodesis the next day. At approximately 1 year, the patient had regained left-sided motor function, whereas severe right-sided weakness and wheelchair dependence persisted. A focused PubMed/MEDLINE review identified eight well-characterized previously published cases that included sufficient data for detailed tabulation of both a spinal arterial aneurysm and CoA. CoA-associated lesions clustered in the cervical and upper thoracic regions and were managed microsurgically, endovascularly, or conservatively, with no comparative evidence favoring one approach. Spinal-predominant SAH should raise suspicion for a spinal vascular source and prompt consideration of cervical vascular imaging. When enlarged spinal or systemic collateral vessels are identified, assessment of the thoracic aorta may also be considered.