Anthony S Larson1,2, Anthony L Mikula3, Waleed Brinjikji4,3, Giuseppe Lanzino4,3. 1. Department of Radiology, Mayo Clinic, 200 1st St. SW, Rochester, MN, USA. Larson.Anthony@mayo.edu. 2. Department of Neurosurgery, Mayo Clinic, 200 1st St. SW, Rochester, MN, USA. Larson.Anthony@mayo.edu. 3. Department of Neurosurgery, Mayo Clinic, 200 1st St. SW, Rochester, MN, USA. 4. Department of Radiology, Mayo Clinic, 200 1st St. SW, Rochester, MN, USA.
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.
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.
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