DOI: 10.12890/2026_006023

Spinal ischemia after prolonged resuscitation and coronary angiography under Impella protection

Authors

  • Anna Rom Department of Internal Medicine, University Hospital Basel, Basel, Switzerland 0009-0006-8206-7883
  • Aikaterini Anastasiou Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland 0000-0002-5405-4237
  • Ioanna Giatagantzidou REHAB Basel, Clinic for Neurorehabilitation and Paraplegiology, Basel, Switzerland
  • Özgür Yaldizli University Hospital Basel, University of Basel (Translational Imaging in Neurology Basel, Department of Biomedical Engineering, Department of Clinical Research and Research Center for Clinical Neuroimmunology and Neuroscience), Basel, Switzerland 0000-0002-0800-4845
  • Jasper Boeddinghaus Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland 0000-0003-4404-4956
  • Marios-Nikos Psychogios Department of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland 0000-0002-0016-414X
  • Daniel Tobias Tuchscherer Intensive Care Unit, Department of Acute Medicine, University Hospital Basel, Basel, Switzerland

anna.rom@outlook.de

Keywords

Cardiac arrest, spinal ischemia, Impella, embolism, hypoperfusion

Abstract

Spinal ischemia is a rare condition and accounts for only 1-2% of all neurovascular diseases. In this case, spinal ischemia occurred in a 46-year-old patient after prolonged resuscitation after out-of-hospital cardiac arrest and following invasive coronary angiography and percutaneous coronary intervention under mechanical circulatory support with an Impella (Abiomed, Danvers, MA, USA). Magnetic resonance imaging showed an infarct demarcation from the 5th thoracic vertebra to the conus medullaris. The supply areas of the anterior spinal artery (paraplegia, no response to pain stimulus) as well as the posterior spinal arteries (reduced sensation of touch) were affected. Magnetic resonance imaging of the brain showed both signs of hypoxic brain damage and embolic events. In terms of pathogenesis, the low-flow-phase of resuscitation with associated arterial thromboembolism as well as a thromboembolic event by the Impella need to be considered. To date, limited data on the prevalence and incidence of spinal ischemia after resuscitation and/or use of an Impella are available in the literature.

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References

  1. Alektoroff K, Kettner M, Papanagiotou P. Spinale Ischämie [Spinal cord ischemia]. Radiologe 2021;61:263-266. German. doi: 10.1007/s00117-021-00825-3
  2. Mullen MT, McGarvey LM. Spinal cord infarction: epidemiology and etiologies. In: UpToDate, Connor RF (Ed), Wolters Kluwer. (Accessed on November 19, 2024).
  3. Mullen MT, McGarvey LM. Spinal cord infarction: clinical presentation and diagnosis. In: UpToDate, Connor RF (Ed), Wolters Kluwer. (Accessed on November 19, 2024).
  4. Cheshire WP, Santos CC, Massey EW, Howard JF Jr. Spinal cord infarction: etiology and outcome. Neurology 1996;47:321-330. doi: 10.1212/wnl.47.2.321
  5. Turkoz A, Gulcan O, Kizilkilic O, Kocum A, Turkoz R. Spinal cord ischemia caused by cardiac arrest secondary to pericardial effusion. J Cardiothorac Vasc Anesth 2007;21:91-92. doi: 10.1053/j.jvca.2005.08.002
  6. Robertson CE, Brown RD Jr, Wijdicks EF, Rabinstein AA. Recovery after spinal cord infarcts: long-term outcome in 115 patients. Neurology 2012;78:114-121. doi: 10.1212/WNL.0b013e31823efc93
  7. Imaizumi H, Ujike Y, Asai Y, Kaneko M, Chiba S. Spinal cord ischemia after cardiac arrest. J Emerg Med 1994;12:789-793. doi: 10.1016/0736-4679(94)90485-5
  8. Xu J, Zhou X, Liu Z, Xu Z. Spinal cord infarction secondary to pulmonary embolism-induced cardiac arrest: a case report. BMC Anesthesiol 2022;22:275. doi: 10.1186/s12871-022-01820-4
  9. Duggal N, Lach B. Selective vulnerability of the lumbosacral spinal cord after cardiac arrest and hypotension. Stroke 2002;33:116-121. doi: 10.1161/hs0102.101923
  10. Marques M, Bao K, Meyer B, Otero M, Velasquez G, Houston P, et al. Acute Ischemic Stroke Incidence and Characteristics After Cardiac Arrest (P7-7.005). Neurology 2025;104:7. doi: 10.1212/WNL.0000000000212174
  11. Hassett CE, Cho SM, Hasan S, Rice CJ, Migdady I, Starling RC, et al. Ischemic Stroke and Intracranial Hemorrhages During Impella Cardiac Support. ASAIO J 2020;66:e105-e109. doi: 10.1097/MAT.0000000000001132

Published

2026-01-28

Issue

Vol. 13 No. 2 (2026)

Categories

How to Cite

1.
Rom A, Anastasiou A, Giatagantzidou I, Yaldizli Ö, Boeddinghaus J, Psychogios M-N, et al. Spinal ischemia after prolonged resuscitation and coronary angiography under Impella protection. EJCRIM [Internet]. 2026 Jan. 28 [cited 2026 Nov. 3];13(2). Available from: https://ejcrim.com/index.php/ejcrim/article/view/6023

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