Discontinuity of the arch beyond the origin of the left subclavian artery in an adult: Interruption or coarctation?

Ruptured cerebral aneurysm in isolated type A interrupted aortic arch managed by transradial endovascular route: A case report with literature review

BACKGROUND AND INTRODUCTION

Interrupted aortic arch (IAA) is a very rare congenital anomaly carrying high neonatal mortality rate if left untreated. Rarer still, is its presentation in teenage or adulthood. This condition has been found to be complicated with cerebral aneurysms, which is a consequence of hemodynamic stress and hypertension secondary to arch interruption. Cerebral aneurysms can further complicate the clinical course and lead to poor clinical outcomes, especially if ruptured.

CLINICAL PRESENTATION

A 17-year-old female presented with ruptured basilar top aneurysm and was considered for endovascular coiling. Transfemoral access was chosen but the catheter could not be negotiated beyond proximal thoracic aorta. A computed tomographic angiography (CTA) of thorax and abdomen was performed, which showed isolated interruption of aortic arch. Subsequently, transradial route was used for coiling of the aneurysm.

CONCLUSION

To the best of our knowledge, the index case is one of the only seven cases of IAA with cerebral aneurysm that have been reported till date in medical literature. It also holds the unique distinction of being the first case of IAA with cerebral aneurysm treated by endovascular approach. Our case highlights the importance of transradial access in such pathological conditions.

Difference and similarity between type A interrupted aortic arch and aortic coarctation in adults: Two case reports

BACKGROUND

Aortic coarctation (CoA) is usually confused with interrupted aortic arch (IAA), especially adult type A interrupted aortic arch, due to their similar anatomical location. Although the main difference between them is whether arterial lumen exhibits continuity or not, the clinical manifestations are similar and connection exists between them. Adult type A IAA is considered as an extreme form of CoA, which is complete discontinuity of aortic function and lumen caused by degenerative arterial coarctation. This paper reports two cases (interrupted aortic arch and severe aortic coarctation) to analyze the difference and similarity between them.

CASE SUMMARY

The two cases of patients presented with hypertension for many years. Computed tomography angiography showed that the aortic arch and descending aorta were discontinuous or significantly narrowed with extensive collateral flow. The IAA patient refused surgical treatment and blood pressure could be controlled with drugs. While the CoA patient underwent stent implantation because of uncontrollable hypertension, the blood flow recovered smoothly and the blood pressures at both ends of the stenosis returned to normal after surgery.

CONCLUSION

Adult type A IAA and CoA have difference and similarity, and type A IAA is associated with CoA to a certain extent. The treatment method should be chosen based on the patient's clinical symptoms rather than the severity of the lesion.