Paraparesis in adult aortic coarctation: Reversal by stent supported angioplasty

Abstract

Aortic coarctation presenting with neurological complications as compressive myelopathy is rare. We report a case of a 43-year-old, hypertensive, female who presented with gradually progressive paraparesis over 4 years. She was diagnosed to be having coarctation of the aorta with intra-spinal collaterals causing compressive myelopathy. She underwent successful percutaneous endovascular implantation of a balloon-expandable aortic stent to relieve her aortic coarctation. This led to regression of her intra-spinal collaterals relieving her cord compression. This nonsurgical modality treatment proved to be safe and effective in relieving her hypertension and neurological complication of paraparesis.

Learning objectives: •To recognize that paraparesis can be a rare manifestation of coarctation of the aorta.•To highlight the importance of treating the primary pathology of coarctation of the aorta in such critically ill therapeutically challenging patients.

Keywords: Aortoplasty; Coarctation of aorta; Paraparesis.

Fig. 1

Pre-stenting multidetector computed tomography angiography images. (A, B) 3D volume-rendered angiographic image (A) with surface shaded colored projection (B) showing tight post-ductal coarctation of the aorta (arrowhead) with post stenotic dilation and multiple prominent tortuous anterior abdominal wall (solid arrow), posterior intraspinal (hollow arrow) collaterals. (C, D) Axial multiplanar reformation images in soft tissue window at lower cervical (C) and upper dorsal (D) levels showing prominent para-vertebral (white arrows) and intraspinal (black arrows) collaterals.

Fig. 2

Pre (A) and post (B) stenting digital subtraction angiography (DSA) image. (A) Pre-stenting DSA showing tight post-ductal coarctation of the aorta with large collaterals. (B) Post-stenting DSA showing a reduction in collaterals and well-expanded coarctation segment after aortic stent implantation.

Fig. 3

Pre (A, B) and post (C, D) stenting multidetector computed tomography angiography images. (A) 3D volume-rendered colored projection showing tight post-ductal coarctation of the aorta with post stenotic dilation, prominent tortuous anterior abdominal wall, posterior intraspinal collaterals. (B) Coronal maximum intensity projection (MIP) images (thickness 5 mm) showing shelf-like tight coarctation of the aorta with prominent paravertebral collaterals (white arrow). Post stenting 3D volume-rendered colored projection (C) and coronal MIP images (thickness 10 mm) (D) showing metallic stent across the stenotic segment with normalization of post stenotic aortic caliber and complete resolution of anterior abdominal wall, paravertebral collaterals.