Abstract 371: Posterior Spinal Artery Territory Infarct Following Endovascular Basilar Artery Stenting For Basilar Artery Aneurysm: A Case Report

Introduction/Purpose Posterior spinal artery infarcts are exceedingly rare due to high level of collateral circulation inthe spinal cord. Additionally thromboembolic phenomenon is a potential complication duringendovascular aneurysm repair via digital subtraction angiography (DSA). Hereby, we report acase of posterior spinal artery infarct following cerebral angiography and endovascular basilarartery pipeline embolization for basilar artery aneurysm. Our goal is to outline successfuldiagnosis and management of this rare event. Materials and Methods A single case report and literature review via PubMed Results Our patient is a 59‐year‐old female with a basilar artery aneurysm. Following treatment of anewly diagnosed unruptured 2.48mm x 2.22 mm proximal basilar artery aneurysm, adjacent toorigin of the right anterior inferior cerebellar artery (AICA) with a Pipeline Embolization Device(PED), she presented as bilateral dorsal cord syndrome. On exam, she had isolated findings ofloss of vibration and joint position sense in her feet and ankles and sensory ataxia, MRI of thecervical spine without contrast showed a small focus of increased T2/STIR signal intensity in thedorsal midline at the level of C2‐3, involving bilateral nuclei gracilis. There was no evidence ofdisc herniation or central canal stenosis. MRI brain without contrast was obtained to rule outbasilar artery perforator stroke given procedure's proximity to basilar perforators, which did notshow a stroke.According to literature, 28 cases with PSAS were identified in 22 articles, 12 cases due toatherosclerosis, 7 cases due to artery dissection and 3 cases of iatrogenic etiology. To ourknowledge, Vertebral artery dissection (VAD) and atherosclerosis were by far the most commonetiology identified in reported cases of Posterior Spinal Artery Syndrome (PSAS). We proposethat in our patient, the constellation of acute onset of symptoms, exam and MRI findings areconsistent with arterial thromboembolism following the PED procedure. Conclusion Although infrequently reported in literature, spinal cord infarct should be recognized as apotential complication of endovascular interventions for lesions of posterior circulation