Spinal cord infarction is an unusual complication of intracranial neuroendovascular intervention

Abstract

Spinal cord infarction is an unusual complication of intracranial neuroendovascular intervention. The authors report on two cases involving spinal cord infarction after endovascular coil embolization for large basilar-tip aneurysms. Each aneurysm was sufficiently embolized by the stent/balloon combination-assisted technique or double catheter technique. However, postoperatively, patients presented neurological symptoms without cranial nerve manifestation. MRI revealed multiple infarctions at the cervical spinal cord. In both cases, larger-sized guiding catheters were used for an adjunctive technique. Therefore, guiding catheters had been wedged in the vertebral artery (VA). The wedge of the VA and flow restriction may have caused thromboemboli and/or hemodynamic insufficiency of the spinal branches from the VA (radiculomedullary artery), resulting in spinal cord infarction. Spinal cord infarction should be taken into consideration as a complication of endovascular intervention for lesions of the posterior circulation.

Keywords: complication; intracranial aneurysm; neuroendovascular intervention; spinal cord infarction.

Figure 1

A wide-necked unruptured basilar-tip aneurysm was thoroughly embolized with a stent/balloon combination assist technique. A) Left vertebral angiogram (Lt. VAG) before embolization. B) Non-subtraction image during coiling showing balloon (arrow) and stent (arrows). C) Lt. VAG after embolization showing that the aneurysm was embolized and bilateral PCAs were successfully preserved. D) Anterior spinal artery (ASA) originating from left VA. E,F) Radiculomedullary artery (artery of cervical enlargement) (double arrow) is derived from the C6 level of the VA, and is filling the ASA (arrows), G) MRI diffusion weighted image acquired 1 day after the operation demonstrating multiple high intensity areas located mostly on the left side. H) MRI T2 weighted image showing spinal infarction at the C3 and C6 levels (arrow).

Figure 2

A wide-necked ruptured basilar-tip aneurysm was totally embolized with a double catheter technique. A) Right vertebral angiogram (Lt. VAG) before embolization. B,C) Rt. VAG after embolization displaying the aneurysm was filled with coils and bilateral PCAs were successfully preserved (B: subtraction and C: non-subtraction images). D) Lt. VAG during procedure showing the flow stagnation of the left vertebral artery due to wedged guiding catheter and vasospasm. E) MRI diffusion weighted image acquired 2 days postoperatively demonstrating multiple high intensity areas bilaterally in the spinal cord. F) MRI T2 weighted image showing spinal cord infarction at the C2/3 level (arrow) and cervical canal stenosis at the C3-5 level.