Cerebral lipiodol embolism related to a vascular lake during chemoembolization in hepatocellular carcinoma: A case report and review of the literature

Ishimaru, Hideki; Morikawa, Minoru; Sakugawa, Takayuki; Sakamoto, Ichiro; Motoyoshi, Yasuhide; Ikebe, Yohei; Uetani, Masataka

doi:10.3748/wjg.v24.i37.4291

Cited by 9 publications

(9 citation statements)

References 24 publications

(44 reference statements)

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“…Other authors reported cases of lipiodol-associated embolic stroke following TACE. 3 4 Lipiodol can penetrate through the tumor into the hepatic veins and cause stroke in patients with right-to-left shunt. In our case, the DEB-TACE and the PVA particles were more than 75 µg, with a very low likelihood of penetration into the hepatic veins given the lack of discernable intratumoral shunts; unless there was an undetectable one, which has an incidence of 2.4%.…”

Section: Discussionmentioning

confidence: 99%

Ischemic Stroke Post-Transradial Chemoembolization

Justaniah,

Omar,

Tashkandi

2024

The Arab Journal of Interventional Radiology

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Transarterial chemoembolization is one of the approved locoregional treatment options for hepatocellular carcinoma. The procedure is safe; however, stroke may happen as one of the rarest complications. Our patient is a 68-year-old male who underwent transradial chemoembolization to treat hepatocellular carcinoma, who then developed ischemic stroke on postoperative day 1. The possible causes of stroke in our patient will be presented with review of the literature. Although rare, stroke post-chemoembolization can happen. The presence of intratumoral shunt or inadvertent injection of air bubbles in a coexisting right-to-left shun or the use of transradial approach can increase the risk of stroke.

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Section: Discussionmentioning

confidence: 99%

Ischemic Stroke Post-Transradial Chemoembolization

Justaniah,

Omar,

Tashkandi

2024

The Arab Journal of Interventional Radiology

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“…TACE treatment in patients with HCC complicated by an AHVS may increase the post-treatment risk of pulmonary embolism, pulmonary infarction, and even cerebral embolism. 24 Furthermore, the histologic toxicity of the chemotherapy drugs may aggravate lung symptoms, such as pulmonary edema, atelectasis, blood pneumothorax, and even respiratory arrest. 25 Therefore, traditional TACE is not ideally appropriate and may even be dangerous for patients with AHVS.…”

Section: Discussionmentioning

confidence: 99%

Retrograde venous coil embolization prior to transarterial chemoembolization in hepatocellular carcinoma with arterio-hepatic venous shunts

Zhu

Qiu

Yan

et al. 2022

Diagn Interv Radiol

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PURPOSE This study explored the clinical efficacy of transcatheter retrograde shunt occlusion with coils to prevent pulmonary oil or particle embolization prior to transarterial chemoembolization (TACE) in patients with artero-hepatic venous shunts (AHVS) secondary to hepatocellular carcinoma (HCC). METHODS From July 2017 to January 2021, 6 patients with advanced, unresectable HCC were found to have an AHVS by hepatic arteriography at the time of attempted TACE. The AHVS was embolized retrogradely with metal coils through a transfemoral or transjugular venous approach. After venous embolization and confirmation of the absence of the AHVS, TACE was performed using an emulsion of iodized oil and doxorubicin or drug-eluting beads. Follow-up computed tomography (CT) was performed within 1 month after the first TACE to evaluate the results and complications. RESULTS Hepatic angiography after venous embolization showed that AHVS had utterly disappeared in all patients during the operation. The immediate technical success of the retrograde venous embolization was 100%. The AHVS had disappeared entirely during the follow-up period through triple-phase enhancement CT scanning. According to the modified response evaluation criteria in solid tumors, TACE in all 6 patients had a disease control response rate of 100% (6/6) with complete response in 2 patients and partial response in 4 patients. One patient died during the 6-month follow-up, and the other 5 were still alive. No complications related to pulmonary embolism occurred. CONCLUSION Retrograde venous coil embolization of AHVS via the draining hepatic vein appears to be a safe, feasible, and effective treatment to allow TACE treatment without pulmonary embolic events. This approach appears to provide better tumor control and effectively decreases the occurrence of pulmonary embolism.

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“…In addition, it is noteworthy that regardless of whether the chemotherapeutic drugs used in TACE can induce or co-induce lung injury, 13 - 15 the suspension formed by the iodinated oil and chemical drugs may cause disruptions on the direct or indirect immune response to lung tissues, including diffused alveolar damage, non-cardiogenic pulmonary edema, vasculitis alveolar hemorrhage, ARDS, and allergic reaction alveolitis. The combination of 2 chemotherapy drugs and iodinated oil in TACE in this group of patients may increase the chemotherapy drug-related pneumonia.…”

Section: Discussionmentioning

confidence: 99%

Clinical Characteristics of Transarterial Chemoembolization in Treatment of Primary Hepatocellular Carcinoma Complicated With Respiratory Distress Syndrome

Ruan

Lin

Xiong

et al. 2020

Technol Cancer Res Treat

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Objective: The present study aims to analyze the clinical characteristics and etiology of transarterial chemoembolization (TACE) in the treatment of hepatocellular carcinoma (HCC) complicated with acute respiratory distress syndrome (ARDS), in order to improve the early diagnosis rate and cure rate. Methods: A total of 816 patients with primary HCC received 2,200 TACE treatments from January 2014 to May 2018. Among these patients, 6 patients developed ARDS after TACE. The clinical data, lesion characteristics, laboratory tests, treatment process and prognosis of 6 patients were retrospectively analyzed. Results: The longest lesion diameter ranged within 5.0-10.2 cm (mean: 6.6 cm) in the 6 patients with primary HCC. Among these patients, 4 patients had lesions mainly located in the left lateral lobe of the liver, while 5 patients had no hepatic arteriovenous fistula detected before TACE. Nedaplatin, epirubicin and iodinated oil suspension chemoembolization were used in all 6 patients during TACE, and all of them experienced ARDS symptoms within 24-48 hours after TACE. However, no clear pathogenic bacteria were incubated in the sputum culture after the onset of the disease. Diffused exudative changes of both lungs were found in the chest X-ray, and the oxygenation index (PaO2/FiO2) was within 100-300 mmHg. The symptoms of 6 patients improved after 3-6 days of hormone therapy. Conclusion: In this study, we found that although the incidence of ARDS after TACE was low in the treatment for HCC, the symptoms after onset were serious, and the early hormone therapy may be beneficial to improve the prognosis and reduce mortality. Further research with larger samples is still needed to confirm the pathogenesis of ARDS after TACE in the treatment for HCC.

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Cerebral lipiodol embolism related to a vascular lake during chemoembolization in hepatocellular carcinoma: A case report and review of the literature

Cited by 9 publications

References 24 publications

Ischemic Stroke Post-Transradial Chemoembolization

Ischemic Stroke Post-Transradial Chemoembolization

Retrograde venous coil embolization prior to transarterial chemoembolization in hepatocellular carcinoma with arterio-hepatic venous shunts

Clinical Characteristics of Transarterial Chemoembolization in Treatment of Primary Hepatocellular Carcinoma Complicated With Respiratory Distress Syndrome

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