Association of aortic coarctation to a cerebral aneurysm in 53-year-old male with coronaropathy: What should be prioritized?

Coarctation of the aorta (CoA) is a common congenital defect, which although normally detected and surgically repaired in childhood. Rarely present in adults. Unless significant hypertension exists, adult patients are usually asymptomatic. We report a case of a 53-year-old Man with cardiovascular risk factors, presented with ccs class II angina and wernicke's aphasia. Further investigation of his aphasia was needed for the evaluation of his hemorrhagic risk under antithrombotic therapy and anticoagulant. These last revealed coarctation of the aorta (CoA) associated to cerebral aneurysm (CA). The patient underwent an angioplasty of his coronary artery disease, then he was presented to surgery for the CA and endovascular repair for the CoA. The issue raised by the case was whether to treat first the CoA or the CA. Although uncommon in adults, aortic coarctation should be included in the differential diagnosis of resistant high blood pressure, since it is associated with significant complications and mortality when untreated as aneurysms.