Pipeline embolization for recurrent vertebral artery thromboembolic events secondary to a misplaced pedicle screw
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Pipeline embolization for recurrent vertebral artery thromboembolic events secondary to a misplaced pedicle screw Anthony S. Larson 1,2
&
Anthony L. Mikula 2 & Waleed Brinjikji 1,2 & Giuseppe Lanzino 1,2
Received: 26 September 2020 / Accepted: 25 November 2020 # Fondazione Società Italiana di Neurologia 2020
Abstract Background Cervical spine instrumentation carries a risk of vertebral artery injury which can cause devastating neurological events. Flow diversion using the Pipeline embolization device (PED) is a commonly used endovascular modality that can treat various vessel wall abnormalities including aneurysms and arterial dissections. Case Description We report the case of a 69-year-old female who presented with multiple cryptogenic strokes secondary to a vertebral artery irregularity from a misplaced pedicle screw. She continued having ischemic infarcts despite maximal medical therapy. The patient was successfully treated with the PED and has not had any further ischemic events at 1-year follow-up. Conclusions To our knowledge, this is the first published case of a chronic vertebral artery abnormality secondary to a misplaced pedicle screw that was treated with flow diversion. This is likely a safe and effective treatment for this rare complication of pedicle screw placement. Keywords Vertebral artery . Pedicle screw . Dissection . Pipeline embolization . Stroke
Abbreviations CT Computed tomography MRI Magnetic resonance imaging PED Pipeline embolization device tPA Tissue plasminogen activator
Prior publications The contents of this paper, in whole or in part, have not been published elsewhere * Anthony S. Larson [email protected] Anthony L. Mikula [email protected] Waleed Brinjikji [email protected] Giuseppe Lanzino [email protected]
Introduction Instrumenting the cervical spine carries the rare risk of vertebral artery injury which can cause devastating neurological events including dissection, hemorrhage, stroke, and death [1]. Such events can occur immediately or in a delayed fashion, potentially multiple years following a procedure [2]. It is therefore important for clinicians to be aware of these potential complications and understand available treatment options. Flow diversion is an effective endovascular technique that can treat aneurysms by channeling blood flow past the abnormal portion of the arterial wall [3]. This allows for endogenous repair of the vessel wall, thereby improving vessel integrity [4, 5]. With increasing experience, flow diversion has been used to treat various vascular pathologies other than aneurysms, such as dissections [5]. We present a case of a patient who presented with recurrent embolic strokes secondary to an iatrogenic vertebral artery dissection that was likely due to pedicle screw misplacement, and was successfully treated with flow diversion using the Pipeline embolization device (PED).
1
Department of Radiology, Mayo Clinic, 200 1st St. SW, Rochester, MN, USA
Case presentation
2
Department of Neurosurgery,
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