Iatrogenic perforation of the internal carotid artery by a transarticular screw: An unusual case of repetitive ischemic stroke

Iatrogenic injury to the carotid artery is an uncommon but well-recognized complication of medical procedures, including cervical spine surgery. A 60-year-old man showed, over an 8-month period, evidence of recurrent cerebral infarcts in the right carotid artery territory. Repeated cardiovascular screening investigations did not lead towards an etiologic factor. Three years earlier, the patient underwent an atlantoaxial fixation procedure by means of transarticular screws because of a traumatic subluxation. An intra-arterial digital substraction angiography showed malpositioning of the fixation screw on the right side with a high grade stenotic lesion of the internal carotid artery and a pseudoaneurysm. The patient was successfully treated with endovascular stenting. Our case report illustrates the relative importance of iatrogenic carotid injury in the differential diagnosis of stroke after cervical spine surgery.