Spinal cord infarction following neurointerventional procedures in the posterior cerebral circulation: a case analysis and systematic literature review.

BACKGROUND

Spinal cord infarction, though rare, represents a severe complication of neurointerventional procedures involving the posterior vertebrobasilar circulation.

METHODS

We report the case of a 49-year-old male with acute basilar artery occlusion treated with staged endovascular therapy. Initial thrombectomy and balloon angioplasty successfully restored basilar artery flow. However, drug-coated balloon angioplasty for residual basilar artery stenosis on the second procedure triggered cervical spinal cord infarction. Based on this case, we conducted a systematic literature review to identify cases of spinal cord infarction following posterior circulation neurointerventions and investigate potential underlying mechanisms.

RESULTS

Among the 18 included studies and our own case report, 28 cases was identified. The mean age of the patients was 59 years, with a male predominance. Clinical manifestations and outcomes varied considerably depending on the level and laterality of spinal cord involvement. Procedure-induced hemodynamic insufficiency in the vertebral artery during neurointerventional procedures was identified as the primary mechanism (17 cases, 60.7%), followed by perioperative direct spinal artery occlusion (6 cases, 21.4%). Other potential contributing factors included systemic hypotension, inadequate antithrombotic management, stent-induced microthrombosis, and prolonged procedural duration.

CONCLUSION

Clinicians must recognize hemodynamic hypoperfusion of spinal cord arteries due to vertebral artery flow disruption as a critical mechanism of this complication. Preoperative assessment of cervical spinal cord hemodynamic vulnerabilities, intraprocedural utilization of small-diameter catheters, and prompt management of vertebral artery flow stagnation are all important measures to mitigate the risk of spinal cord infarction.