Complications of Vertebral Artery Catheterization

Abstract

EGAS MONIZ, the originator of carotid angiography, was at first reluctant to attempt vertebral artery injection because of the importance of the structures supplied by this vessel and because of the difficulty of obtaining access to it by surgical exposure. Subsequently he and his coworkers (1) introduced retrograde subclavian artery injection after supraclavicular exposure of the vessel. Olivecrona (2) made injections into the exposed vertebral artery. Shimidzu (3) described retrograde subclavian artery injection following percutaneous puncture. In 1940 Takahashi (4) described a method requiring percutaneous puncture of the vertebral artery as it courses through the foramina transversaria, but this procedure has not received widespread acceptance in the United States. A more widely used method of delivering a contrast agent to the vertebral artery without introduction of a catheter or direct trauma to that artery employs countercurrent injection into the brachial artery in the region of the antecubital fossa (5, 6). This method, however, does not regularly produce the contrast achieved in the posterior fossa vessels by selective injection. Catheter methods recently achieving popularity in the United States offer a selective technic which is relatively easy to perform and yields high-quality radiographs. The procedure eliminates two recognized complications of percutaneous vertebral angiography—vertebral arteriovenous fistula and accidental injection into the subarachnoid space. Recent literature fails, however, to stress adequately the potential hazards common to selective catheterization and percutaneous puncture. This paper presents three cases which demonstrate complications of selective vertebral artery catheterization. Case I: A 23-year-old male was admitted to the University of Kentucky Medical Center with a history of progressive headache, dizziness, vertigo, ataxia, nausea, and vomiting for the past year. General and neurological examinations were normal except that caloric stimulation showed loss of vestibular function on the right. Skull radiographs were normal. Vertebral angiography by the transfemoral technic was performed. A test injection immediately following insertion of the catheter into the vertebral artery showed sluggish flow of the contrast agent away from the catheter tip. Shortly thereafter the patient complained of severe bilateral scapular pain associated with numbness and tingling of the forearms and hands and inability to move the fingers. The catheter was then withdrawn from the vertebral artery. Biceps and triceps muscles were strong on both sides, but profound weakness of the intrinsic muscles of the hands and moderate weakness of the wrists were noted. The angiographic procedure was carried out by injection into the subclavian artery at the vertebral orifice.