Spinal Angiography

Abstract

Catheter angiography of the spine is much less common than cerebral angiography, but it remains the gold standard for imaging spinal vasculature. Non-invasive imaging of spinal vasculature, including high resolution MRA or CTA, can sometimes be helpful to screen for larger vascular abnormalities, but fails to provide precise information regarding fl ow patterns and collateral fl ow; many times the vessels of interest are below the spatial resolution of these non-invasive modalities. Diagnostic spinal angiography is also typically done as the fi rst step during neurointerventional procedures involving the spine and spinal cord. The techniques and skills required for spinal angiography can overlap those required for cerebral angiography, since the upper cervical spine and spinal cord are supplied by the vertebral arteries. However, the spine extends from the base of the skull to the sacrum, and imaging the vasculature is a procedure entirely different from cerebral angiography. Indications1. Evaluation of patients with myelopathy, suspected to have spinal dural arteriovenous fi stulas (most common indication). 2. Evaluation of patients with known or suspected spinal arteriovenous malformations or vascular neoplasms (e.g., with spinal intramedullary or subarachnoid haemorrhages). 3. Rarely for evaluation of suspected spinal cord ischemia ischaemia (since cord blood supply is so variable, and treatment options for cord ischaemia are so limited, angiography is mainly done to rule out a fi stula as the cause of symptoms). 4. Planning for neurointerventional procedures on spine or spinal cord. 5. Pre-op mapping of cord vasculature prior to spinal or aortic procedures that risk occlusion of the spinal vessels. 6. Intra-operative assistance with surgery on spinal vascular lesions. 7. Follow-up imaging after treatment (e.g., after treatment of arteriovenous fi stulas or malformations). Complications of Diagnostic Spinal AngiographyInformed consent prior to an angiogram should include a discussion of the risk of complications. Neurological ComplicationsNeurological complications in spinal angiography may include the same risk of cerebral ischaemic events that may occur during cerebral angiography when the cervical region is being studied (see Chap. 2 ). In addition, there is the risk of vessel dissection, embolic occlusion with thrombus, atherosclerotic plaque, or air emboli occluding the spinal cord vessels and producing myelopathy. Forbes et al. reported that a series of 134 spinal angiograms had three (2.2%) neurological complications, all transient. spinal cord (although not necessarily performed as part of spinal angiography) has also been shown to produce temporary or permanent injury to the spinal cord. 4-6 Non-neurological ComplicationsNon-neurological complications of spinal angiography via the femoral artery include the same local and systemic complications seen in cerebral angiography (as seen in Chap. 2 ). Forbes reported 8.2% puncture-site complications and 3.7% systemic complications from spinal angiography.1 ...