Anterior Cord Syndrome after Embolization for Malignant Hemoptysis

Abstract

Interventional radiology plays an integral role in the management of massive and recurrent submassive hemoptysis. Risks of bronchial artery embolization (BAE) are well described and include spinal ischemia and paralysis, most often related to nontarget embolization of the artery of Adamkiewicz or other large radiculomedullary artery supplying the anterior spinal artery. There is increasing literature regarding spinal infarction following BAE when arterial supply to the spinal cord was not evident. The existence of unrecognized patient comorbidities may further contribute to procedural risks.

The Spinal Wada Test: Adapting a Neurointerventional Technique for Bronchial Artery Embolization

“…Spinal cord infarction can be due to anomalous origin of the anterior spinal artery, subtle or invisible spinal artery feeding vessels, or reflux of embolic materials. Techniques including use of PVA particles or embospheres larger than 350um (typically 500-700um), superselective catheterization, and intermittent angiography during embolization mitigate the risk of off target embolization, but spinal cord infarction continues to be reported and published [4,5]. In cases of equivocal visualization of radiculomedullary arteries, provocative testing can provide another tool to assess for spinal artery anastomosis, allowing the practitioner to assess the risk of spinal cord infarction and determine whether to proceed with embolization.…”