Spinal Ischemia after Prolonged Resuscitation and Coronary Angiography Under Impella Protection

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 5^th 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.

Impella (ventricular assist device) can be associated with thromboembolic events.The low flow phase of resuscitation can be associated with arterial thromboembolism.Spinal ischemia can occur after resuscitation.