PMC9610604_01
(a) Anteroposterior view of a right vertebral artery (VA) angiogram shows the unruptured basilar tip aneurysm. The tip of the guiding catheter was not wedged, and there was good flow around the guiding catheter. The anterior spinal artery was not visualized in this angiogram throughout the procedure. (b) Anteroposterior view of a right VA angiogram just after coil embolization shows that the aneurysm was successfully embolized, without signs of reduced VA flow.
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F1
The tip of the guiding catheter was placed in the distal end of the V2 segment and a VA angiogram confirmed no findings of decreasing contrast flow from the arterial to venous phases [Figure 1a]. Stryker Neurovascular, Fremont, CA, USA) and compliant balloon (SHOURYU 4 mm x 7 mm; Kaneka Medics, Kanagawa, Japan) was performed. Six coils were inserted into the aneurysm, with preservation of the bilateral posterior cerebral arteries [Figure 1b].
Coronal diffusion-weighted image (a) and axial (b), coronal (c), and sagittal (d) views of T2-weighted images of cervical magnetic resonance imaging on postoperative day 4 show spinal cord infarction at the level of the C2-3 vertebral body (arrows).
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F2
Four days after the intervention, the patient noted left thermal hypoalgesia, and cervical MRI revealed spinal cord infarction associated with spinal cord swelling on the right side at the level of the second and third cervical vertebral body [Figures 2a-d]; this seemed likely to have caused the symptoms.
Anteroposterior views of the right (a) and left (b) vertebral artery angiograms obtained 4 weeks after the treatment show no opacification of the anterior spinal artery.
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F3
ASAs [Figures 3a and b]. A coronal CBCT scan of the right VA showed an avascular area consistent with spinal cord infarction [Figure 4a, blank arrow].
Reconstructed cone-beam computed tomography (CBCT) scans obtained 4 weeks after coil embolization. A coronal view of the right (a) vertebral artery (VA) shows an avascular area consistent with spinal cord infarction (blank arrow). Arrows indicate radiculomedullary arteries (RMAs) at the level of C4 and C5. An axial CBCT view of the right VA at the level of C3 (b) shows faint opacification around the spinal cord; however, an axial view of the left VA at the same level [Figure 4c] showed clear opacification of the left side of the spinal cord. On the other hand, an axial CBCT view of the right VA at the level of C4 [Figure 4d] showed clear opacification of the bilateral spinal surface pial vessels. A coronal CBCT scan of the left VA showed clear opacification of the RMA [Figure 4e], arrow) connected to an anterior spinal artery.
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F4
ASAs [Figures 3a and b]. A coronal CBCT scan of the right VA showed an avascular area consistent with spinal cord infarction [Figure 4a, blank arrow]. Although an axial CBCT view of the right VA at the level of C3 [Figure 4b] showed faint opacification around the right side of the spinal cord, an axial view of the left VA at the same level [Figure 4c] showed clear opacification of the left side of the spinal cord. On the other hand, an axial CBCT view of the right VA at the level of C4 [Figure 4d] showed clear opacification of the bilateral spinal surface pial vessels. CBCT scan of the left VA showed clear opacification of the RMA [Figure 4e], arrow) connected to an anterior spinal artery. Cervical MRI 28 days after the intervention showed an improvement in spinal cord edema; the final extent of the infarction was well defined [Figures 5a-c, arrows].
Follow-up axial (a), coronal (b), and sagittal (c) views of T2-weighted cervical magnetic resonance images 4 weeks after intervention show the final extent of the cervical spinal infarction (arrows).
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F5
CBCT scan of the left VA showed clear opacification of the RMA [Figure 4e], arrow) connected to an anterior spinal artery. Cervical MRI 28 days after the intervention showed an improvement in spinal cord edema; the final extent of the infarction was well defined [Figures 5a-c, arrows].