Angiosuite-Based Awake Closed Reduction With Neurointerventional Standby for Cervical Fracture-Dislocation With Vertebral Artery Injury: A Technical Report.

Cervical fracture-dislocation with vertebral artery injury (VAI) creates a treatment dilemma between urgent spinal realignment and cerebrovascular protection. We describe a hybrid workflow in which awake closed reduction is performed in the angiography suite with neurointerventional standby and report its feasibility in three patients. Between April 2023 and June 2024, patients with confirmed VAI underwent brain MRI and CT angiography (CTA), followed by transfer to the angiosuite. Arterial access and diagnostic angiography were performed before awake closed reduction under neurological monitoring. Endovascular rescue, including parent artery occlusion or thrombectomy, was available if neurological deterioration occurred. Closed reduction was successful in two patients, while one required intraoperative open reduction. One patient underwent pre-reduction coil embolization. These illustrative cases demonstrate the technical implementation and feasibility of the proposed workflow.