Technical Note: A serendipitous discovery - Incidental coarctation of the aorta during transfemoral embolization of a ruptured anterior communicating artery aneurysm

Abstract

We present the first case of endovascular treatment of a ruptured anterior circulation aneurysm via a transradial approach in a patient with undiscovered aortic coarctation (CoA).A 29 year old male patient presented to the emergency department with a 1 day history of sudden-onset headache and vomiting.CT and CTA confirmed presence of acute subarachnoid haemorrhage and an anterior communicating (ACOM) artery aneurysm.Transfemoral endovascular angiography with a view to coiling was performed, however resistance was encountered distal to the aortic arch. On-table chest radiography demonstrated bilateral inferior rib notching confirming suspicion of a CoA.The procedure was converted to transradial access. The ACOM aneurysm was successfully coiled.This case highlights several important learning number points with particular regard to the rising era of transradial neuroendovascular management.