Emergent salvage of the vertebral artery with flow diverter pipeline stent following vessel laceration: Systematic literature review and illustrative case example.

Abstract

Background: Iatrogenic injury to neck vasculature is a potentially life-threatening complication of spine surgery. We present an illustrative case describing the use of the Pipeline^TM Embolization Device (PED) in the emergent reconstruction of the vertebral artery (VA) following vessel laceration. In addition, we document a systematic review concerning the use of the PED in acute to chronic iatrogenic injury of the internal carotid or VAs.

Methods: This study was a systematic literature review and illustrative case example.

Results: A 73-year-old woman underwent anterior cervical discectomy and fusion (ACDF) surgery complicated by left VA injury. The incision was promptly packed and pressure held while the vessel was salvaged using a Pipeline^TM stent. At 6 months follow-up, the patient had no residual symptoms. A systematic review identified 11 publications meeting study criteria, in which 16 patients were reported to have an injury to the internal carotid or VAs. Patients were grouped into acute, subacute, and chronic cohorts. In the acute group, the majority of patients experienced injury during transsphenoidal resection or ACDF procedures. All cases in the acute group received immediate intervention with the deployment of a PED device. One patient experienced continued contrast extravasation, necessitating vessel sacrifice through superficial temporal artery-middle cerebral artery bypass. All patients recovered to their neurologic baseline. In the subacute and chronic groups, two patients experienced complications, with the majority going on to recover to their neurologic baseline.

Conclusion: PED placement is a viable management strategy for restoring anatomic integrity to head-and-neck vasculature following acute iatrogenic injury.