Posterior Circulation Intervention but Mind the Spinal Cord

Spinal cord infarction (SCI), a rare complication following endovascular treatment of posterior circulation aneurysms, is infrequently recognized in the periprocedural period. We illustrate the same with digital subtraction angiography and diffusion-weighted magnetic resonance imaging in this series of two cases. Categorically, the anterior spinal artery was patent, post-procedure, in both instances. Likely, guiding catheter-induced local flow alterations initiates the pathogenesis. A subsequent insufficiency of radiculomedullary artery (RMA) reinforcements is the probable mechanism leading to hemodynamic compromise. Our observations further reiterate that periprocedural antiplatelet therapy is conceivably ineffective in preventing SCI. Besides, advanced age and uncontrolled hypertension could potentially exacerbate the periprocedural RMA compromise. Due vigilance is required to recognize this rare and potentially life-threatening complication in posterior circulation neurovascular intervention.