Iatrogenic perforation of the internal carotid artery by a transarticular screw: an unusual case of repetitive ischemic stroke.
Iatrogenic injury to the carotid artery is an uncommon but well-recognized complication of medical procedures, including cervical spine surgery. A 60-year-old man showed, over an 8-month period, evidence of recurrent cerebral infarcts in the right carotid artery territory. Repeated cardiovascular screening investigations did not lead towards an etiologic factor. Three years earlier, the patient underwent an atlantoaxial fixation procedure by means of transarticular screws because of a traumatic subluxation. An intra-arterial digital substraction angiography showed malpositioning of the fixation screw on the right side with a high grade stenotic lesion of the internal carotid artery and a pseudoaneurysm. The patient was successfully treated with endovascular stenting. Our case report illustrates the relative importance of iatrogenic carotid injury in the differential diagnosis of stroke after cervical spine surgery.
Bogaerde
Michel Vanden
MV
Department of Neurology, University Hospital of Leuven, Herestraat 49, 3000 Leuven, Belgium. vanden_bogaerde@yahoo.com
Viaene
Pieter
P
Thijs
Vincent
V
D017541:Aneurysm, False / Q000175:diagnosis / Q000209:etiology; D015901:Angiography, Digital Subtraction; D001863:Bone Screws / Q000009:adverse effects*; D002340:Carotid Artery Diseases / Q000175:diagnosis / Q000209:etiology; D020212:Carotid Artery Injuries / Q000175:diagnosis / Q000209:etiology*; D002341:Carotid Artery Thrombosis / Q000175:diagnosis / Q000209:etiology; D016893:Carotid Stenosis / Q000175:diagnosis / Q000209:etiology*; D002533:Cerebral Angiography; D002574:Cervical Vertebrae / Q000293:injuries / Q000601:surgery*; D003937:Diagnosis, Differential; D004868:Equipment Failure; D006801:Humans; D007049:Iatrogenic Disease; D020244:Infarction, Middle Cerebral Artery / Q000175:diagnosis / Q000209:etiology*; D020762:Infarction, Posterior Cerebral Artery / Q000175:diagnosis / Q000209:etiology*; D004204:Joint Dislocations / Q000601:surgery; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology*; D012008:Recurrence; D013123:Spinal Fusion / Q000009:adverse effects*; D013124:Spinal Injuries / Q000601:surgery