Who wants to see yet another M1 thrombectomy when vessels like The Lateral Spinal Artery are on the line?

By way of quick introduction, the Lateral Spinal Artery (same as posterior spinal artery at upper cervical cord) is an important vessel with significant embryonic and adult relationships to the PICA.  See those pages for more info on how.  Because the Lateral Spinal Artery supplies lateral cervical and lateral medullary areas, its occlusion can produce a Wallenberg-type stroke (same as occlusions of the PICA ostium, because lateral medullary perforators from the vertebral artery or proximal PICA are homologs of the Lateral Spinal Artery )

Acute onset of dysarthria, hemibody numbness, vertigo

CTA shows occlusion of right vert distal to PICA with a short stump at VB junction


Left vert shows retrograde flow into stump of terminal right vert (arrows). The anterior spinal artery is marked by yellow arrow

Stereo views

Anaglyph stereo


Right vert shows occlusion past EXTRADURAL PICA.  The key is that PICA is extradural.  Which means that there will be a lateral medullary perforator (lateral spinal) coming off the intradural vertebral artery — meaning the occluded segment

Native view to show extradural C1 origin (arrows) of PICA

Aspiration with Jet D. Proximal support (not shown) courtesy of 6F Shuttle in right subclavian.

Post-thrombectomy distal emboli check

Stereo views of revascularized territory — can u see the lateral spinal artery? Exactly like anatomy predicts — C1 origin PICA comes with an intradural lateral spinal/lateral medullary perforator

Anaglyph stereos

Partial background view stereo.  See it?


Here are the arrows

Cool, right.  Again, knowledge of anatomy is important.  C1 origin PICA means there will be a lateral medullary perforator present cranially.  Here it is a large lateral spinal artery.

See also

Lateral Spinal Artery Aneurysm

Bihemispheric PICA Lateral Spinal Infarct

C1 Fistula Lateral Spinal Artery Endovascular and Open Surgical Treatment