Spinal Infarction Following Bilateral Common Iliac Artery Stenting: A Rare Case Report.

Abstract

Spinal cord infarction is an uncommon but devastating complication of vascular and endovascular procedures and is rarely reported after iliac artery interventions. We present a 53-year-old woman with severe bilateral common iliac artery stenoses (>90%) who underwent endovascular revascularization via bilateral femoral access with deployment of a terminal aortic covered stent-graft and bilateral "kissing" covered common iliac artery stents. The procedure was angiographically successful with restoration of inline aortoiliac flow. Within the first few postoperative hours, the patient developed acute bilateral lower-extremity weakness progressing rapidly to complete paraplegia. Spinal MRI demonstrated long-segment acute ischemia/infarction at the thoracolumbar level (T11-L2) with diffusion restriction and low ADC values. Despite supportive management, there was no neurological recovery during hospitalization, and the patient remained paraplegic at discharge. This case underscores that spinal cord infarction, although exceedingly rare, can occur after aortoiliac stenting, likely related to procedure-associated microembolization and/or compromise of pelvic-paraspinal collateral pathways, and highlights the need for careful pre-procedural risk assessment and vigilant post-procedural neurological monitoring in high-risk patients.