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Many atherothrombotic complications are associated with coronary angiography. Spinal cord embolism with high morbidity and mortality is one of these complications.
Case report.
A 65-year-old woman was admitted to the hospital with acute myocardial infarction. Immediately after coronary angiography, she complained of paresthesia and paraparesis of h...
Context in source publication
Context 1
... resonance (MR) and diffusion MR imaging performed 1 day after the procedure showed an acute ischemic lesion in the region of the conus medullaris exhibiting hyperintensity and lack of diffusion in T2A (Figure 1). Widespread atherosclerotic structure and plaque were also seen in MR angiography ( Figure 2). ...
Citations
... Despite a thorough literature review, we noticed that mainly case reports described the occurrence of SCI as a complication of PCI. We found four case reports [7][8][9][10]; one was in Spanish with an English translation of the abstract only [10], so data was collected from there for writing this review. One case was described and presented as a poster at the 2020 Annual Meeting of the American Academy of Neurology (Abstract: Sista SR, Nersesyan H. Ischemic Myelopathy as a Perioperative Complication of Percutaneous Coronary Intervention via Femoral Approach; 29/04/2020; https://www.aan.com/MSA/Public/Events/AbstractDetails/44696). ...
... With a total of seven patients, 57% were male with a median age of 66 years (range: 47-80 years). The access site was the femoral artery in three cases (42.9%) [8,9] (Abstract: Sista SR, 29/04/2020) whereas in all other patients, it was not specified [7,10,11]. Four patients (57.1%) developed low back pain accompanied by bilateral lower limb weakness and decreased sensation [7,9,10,11], where 50% of them had decreased tendon reflexes [7,9], and one patient had reduced anal sphincter control [10]. ...
... Four patients (57.1%) developed low back pain accompanied by bilateral lower limb weakness and decreased sensation [7,9,10,11], where 50% of them had decreased tendon reflexes [7,9], and one patient had reduced anal sphincter control [10]. Three out of seven patients (42.9%) didn't complain of back pain [8,11] (Abstract: Sista SR, 29/04/2020), yet two of them had lower limb weakness and paresthesia bilaterally [8,11]. One patient, however, had only right lower limb weakness (Abstract: Sista SR, 29/04/2020). ...
Spinal cord infarction (SCI) is an uncommon vascular syndrome that leads to neurologic abnormalities with multiple implicated causes. Percutaneous coronary intervention (PCI) is a non-surgical invasive procedure used to relieve an arterial occlusion or narrowing that causes ischemia to the heart. This is usually performed by different methods and different arterial access sites. Here, we present a case of a patient who developed bilateral lower limb weakness eight days after a femoral artery PCI and was diagnosed with SCI. This case report aims to document a rare complication and highlight the most important demographic, investigation, management, risk factors, and prognosis data available in the literature.
... [1] Salvador et al reported that the most common causes of spinal cord infarction (excluding spinal disorders, tumors, and inflammatory lesions) were idiopathic (36.1%), followed by aortic surgery (25%), arteriosclerosis and embolism (19.4%), systemic hypoperfusion (e.g., cardiac arrest and hypovolemic shock) (11.1%), and aortic lesions without surgery (8.3%); however, spinal cord infarction has also been reported as a complication of PCI, IABP, and VA-ECMO. [3][4][5][6] Spinal cord infarction due to VA-ECMO is very rare, with only few cases reported in the literature (Table 1). We suggest a causal relationship in our case as there were no neurological signs or symptoms before VA-ECMO. ...
... Therefore, the possibility that a plaque was destroyed due to operating of the catheter cannot be discounted. [4][5][6] However, catheterization was performed for IABP and extracorporeal membrane oxygenation (ECMO), meaning that the infarction in our case was likely not PCI-specific. ...
Background:
Spinal cord infarction is a rare central nervous system angiopathy that impairs motor, sensory, and autonomic nerves and occurs due to various reasons. This study reports a case of spinal cord infarction in a patient following myocardial infarction that was managed by veno-arterial extracorporeal membrane oxygenation (VA-ECMO).
Case summary:
A 78-year-old Japanese man visited the emergency department with a complaint of chest tightness. He had a history of hypertension, dyslipidemia, diabetes, chronic renal failure, and postoperative bladder cancer. Myocardial infarction was diagnosed after ST elevation in lead aVR was identified by electrocardiogram during the visit, and cardiopulmonary arrest occurred twice during our examination and treatment. After percutaneous coronary intervention with an intra-aortic balloon pump and VA-ECMO, the patient was admitted to the intensive care unit. His circulation stabilized, and he was withdrawn from the intra-aortic balloon pump on day 3 of illness and from VA-ECMO on day 4. However, his consciousness remained impaired. When the patient's consciousness improved on day 14, lower limb weakness was identified. Magnetic resonance imaging conducted on the following day revealed spinal cord infarction in the 5th to 12th thoracic vertebrae.
Conclusion:
Spinal cord infarction due to VA-ECMO is extremely rare but has a poor neurological prognosis upon onset. Necessary countermeasures include conducting regular neurological examinations and high blood pressure maintenance, which is very difficult in VA-ECMO patients. Therefore, patient care will benefit from the experiences reported in such cases.
... It is often associated with severe prognosis and permanent sequelae [1,2]. Coronary angiography and intra-aortic balloon pump (IABP) may cause SCI [3][4][5], as well as venoarterial-extracorporeal membrane oxygenation (VA-ECMO). This latter condition has only been reported as small case series; one patient with refractory cardiac arrest due to myopericarditis [6], and a short case series of three patients with a combination of VA-ECMO and IABP [7]. ...
Spinal cord infarction (SCI) is a rare disease among central nervous system vascular diseases. Only a little is known about venoarterial extracorporeal membrane oxygenation (VA-ECMO)-related SCI. Retrospective observational study conducted, from 2006 to 2019, in a tertiary referral center on patients who developed VA-ECMO-related neurovascular complications, focusing on SCI. During this period, among the 1893 patients requiring VA-ECMO support, 112 (5.9%) developed an ECMO-related neurovascular injury: 65 (3.4%) ischemic strokes, 40 (2.1%) intracranial bleeding, one cerebral thrombophlebitis (0.05%) and 6 (0.3%) spinal cord infarction. Herein, we report a series of six patients with refractory cardiogenic shock or cardiac arrest receiving circulatory support with VA-ECMO who developed subsequent SCI during ECMO course, confirmed by spine MRI after ECMO withdrawal. All six patients had long-term neurological disabilities. VA-ECMO-related SCI is a rare but catastrophic complication. Its diagnosis is usually delayed due to sedation requirement and/or ICU acquired weakness after sedation withdrawal, leading to difficulties in monitoring their neurological status. Even if no specific treatment exist for SCI, its prompt diagnosis is mandatory, to prevent secondary spine insults of systemic origin. Based on these results, we suggest that daily sedation interruption and neurological exam of the lower limbs should be performed in all VA-ECMO patients. Large registries are mandatory to determine VA-ECMO-related SCI risk factor and potential therapy.
... Few cases of SCIs have been reported as a complication from coronary angiography, resulting in lower extremity weakness and numbness [15,16]. The proposed mechanism in these previously reported cases were mechanical trauma due to catheter manipulation resulting in plaque rupture with subsequent embolization. ...
Context
We describe a case of unilateral posterior upper cervical spinal cord infarction and propose a pathophysiologic mechanism causing this lesion after vertebral artery endovascular intervention.
Findings
A 70-year-old male presented with subacute onset of left hemibody sensory changes and gait instability following a left vertebral angioplasty procedure. MRI cervical spine revealed upper posterior cervical spinal cord infarction (PSCI). After 3 months patient had substantial improvement of his symptoms.
Conclusion
PSCI is rare but can present as a complication from vertebral artery angioplasty procedure. Early diagnosis of PSCI can be achieved with adequate understanding of its clinical signs and the blood supply of the spinal cord.
... El infarto de la médula espinal ocurre aproximadamente en el 1% de todos los eventos vasculares cerebrales, y la etiología asociada más frecuente es la cirugía aórtica [4][5][6][7] relacionada con isquemia causada por deterioro hemodinámico intraoperatorio de la médula espinal, así como embolismo en las regiones torácica y lumbar. El embolismo cardíaco es una causa de infarto al sistema nervioso central y puede obedecer a diversos mecanismos. ...
... A pesar de que el embolismo ateromatoso espinal es más frecuente que una causa cardíaca de embolismo debido a procedimientos endovasculares, procedimientos quirúrgicos, anticoagulación, tratamiento trombolítico y traumatismo [6,[11][12][13], en nuestro paciente se descartó ateromatosis o disección de la aorta ascendente y del callado a través de estudios hemodinámicos, además de que la lesión aórtica a este nivel se espera que afecte a porciones medulares más bajas que las que se presentaron en nuestro paciente, debido a las características anatómicas vasculares. El paciente tampoco presentó nunca clínica sugerente de disección vertebral. ...
Introduction:
Spinal infarction accounts for 1% of all strokes. Cardioembolism is a rare cause. Common areas of ischemic spinal damage are watershed in the dorsal or lumbar regions; however cervical spinal cord infarction has been reported previously.
Case report:
We present a new case of a man-in-the-barrel syndrome produced by cardiac embolization associated with atrial fibrillation during an acute myocardial infarction, which caused cervical ischemic neuronopathy (infarction of the anterior horn).
Conclusions:
Classic features of cervical spinal cord ischemia are acute tetraplegia, bladder, bowel and cardiovascular dysfunction and dissociate sensory loss. Incomplete collateralization and anatomical characteristics of the circulation of the anterior spinal artery in the cervical spinal cord, makes of the portion C3 to C5, the most vulnerable portion to ischemic damage, since the radicular arteries supply begins bellow C5 and the pathophysiology of a fast fresh clot lysis produced unique bilateral neuronal horn cells damage.
... Few papers have described lumbar spinal cord infarction after coronary angiography. those reports speculated that inappropriate guidewire/catheter manipulation at the level of iliac artery might cause such a complication [12][13][14] . In our cases, improper handling of the guidewire/catheter was not found when advancing the guiding catheter except for the wedge of the catheter and catheter-induced va- ...
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.
Acute ischaemic stroke is a known risk of percutaneous coronary intervention (PCI). The incidence of such complications has increased in frequency over the last decade due to higher comorbidity burden and increased complexity of PCI procedures. The overall incidence of post-PCI ischaemic stroke remains low at 0.56%, but some groups of patients have significantly higher risk. Risk factors include atherosclerotic plaques, atrial fibrillation, cardiogenic shock, older age and arterial disease. Although the overall incidence of acute ischaemic stroke following PCI is low, it can result in lifelong disability and is associated with high morbidity, mortality and significant costs. Spinal infarctions due to PCI are exceedingly rare. Here, we discuss a 71-year-old woman who presented with a non ST-elevation myocardial infarction and developed both stroke and spinal infarction post PCI due to a thromboembolic event resulting in long-term debility.
Objectives:
Acute spinal cord ischemia syndrome (ASCIS) due to coronary invasive intervention is rarely seen. In this case report we wish to highlight the mortality and morbidity of this entity.
Methods:
Case report.
Results:
A 60-year-old woman, diagnosed with acute myocardial infarction, presented with paresthesia and paraparesis of her legs after coronary invasive intervention. Magnetic resonance imaging showed hyperintensity from T6 to T10 consistent with ASCIS. Despite immediately starting rehabilitation program the patient never regained ambulation.
Conclusion:
Spinal cord infarction secondary to coronary intervention is rare, but when it presents the mortality and morbidity are high.
