Multiple Ischemic Strokes after Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma with a Radiographic and Pathological Correlate

Zach, Victor; Rapaport, Beth; Yoo, Ji Yeoun; Goldfeder, Lara B.; Weinberger, Jesse

doi:10.1016/j.jstrokecerebrovasdis.2010.08.001

Cited by 16 publications

(16 citation statements)

References 17 publications

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“…10 Patients with CLE after TACE and our patient demonstrate foci of restricted diffusion, suggesting a possible component of small vessel/capillary occlusive disease from the lipiodol; however, the delay between the procedure and symptom onset argues against a hyperacute arterial ischemic stroke as the sole explanation for clinical symptoms. 11 Our patient had symptom onset 5 hours after his procedure, consistent with previous reports that describe symptom onset ≤6 hours from the exposure in >85% of cases. 5 The amount of contrast that reaches the brain may influence occurrence and severity of CLE.…”

Section: Discussionsupporting

confidence: 91%

Cerebral Lipiodol Embolism after Lymphatic Embolization for Plastic Bronchitis

Kirschen

Dori

Itkin

et al. 2016

The Journal of Pediatrics

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An adolescent with plastic bronchitis due to congenital heart disease had altered mental status after an interventional lymphatic procedure in which lipiodol contrast was used. Neuroimaging revealed cerebral lipiodol embolization due to direct shunting between lymphatic channels and pulmonary veins. Cerebral lipiodol embolization is a potential neurologic morbidity associated with interventional lymphatic procedures.

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Section: Discussionsupporting

confidence: 91%

Cerebral Lipiodol Embolism after Lymphatic Embolization for Plastic Bronchitis

Kirschen

Dori

Itkin

et al. 2016

The Journal of Pediatrics

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“…In addition pulmonary embolism may have facilitated the opening of pre-existent pulmonary AV shunts by increasing the pulmonary arterial pressure [7]. Similar to our patient, at least six CLE cases have been reported, where HCC was in part supplied by the right IPA [4,7,8]. Shunting between the IPA and the pulmonary venous systems was not detected; thus, direct embolization is an unlikely source of brain emboli.…”

Section: Discussionsupporting

confidence: 72%

“…Cerebral iodized lipid embolism is a relatively rare complication of TAE/TACE with <20 cases published in the literature thus far [7,8]. To our best knowledge, ours is the first case reported from a European country.…”

Section: Discussionmentioning

confidence: 90%

Cerebral iodized lipid embolization via a pulmonary arteriovenous shunt: rare complication of transcatheter arterial embolization for hepatocellular carcinoma

et al. 2013

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We report the first European case of cerebral iodized lipid embolism post transcatheter arterial embolization for hepatocellular carcinoma. Lipiodol emboli and corresponding multifocal brain ischemia were documented with computed tomography (CT) and magnetic resonance (MR) in the acutely symptomatic patient. Transcranial Doppler sonography with contrast indicated a right-to-left shunt, while on a follow-up CT scan lipiodol embolization was detected in both lungs. Dilated pulmonary vessels and thick vascular channels were seen in the vicinity of the right diaphragm suggestive of pulmonary arteriovenous shunt. The patient symptoms regressed with supportive care alone, but he died 5 months later due to hepatic failure unrelated to the procedure.

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“…This was likely due to the reflux of the contrast and DEB particles mixture from an extrahepatic feeding artery (mammary artery) into the basilar artery that resulted in ischemic injury to the cerebellum. To our knowledge, 12 other cases with 25% mortality are reported in the literature 31 . Our patient, however, died of liver failure 5 months after the procedure.…”

Section: Discussionmentioning

confidence: 50%

Survival of patients with intermediate stage hepatocellular carcinoma treated with superselective transarterial chemoembolization using doxorubicin-loaded DC Bead under cone-beam computed tomography control

Popovič

Štabuc

Janša

et al. 2016

Radiology and Oncology

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BackgroundThe purpose of this retrospective study was to evaluate treatment response, adverse events and survival rates of patients with intermediate stage HCC treated with superselective doxorubicin-loaded DC Bead transarterial chemoembolization (DEBDOX) under cone beam computed tomography (CBCT) control.Patients and methodsBetween October 2010 and June 2012, 35 consecutive patients with intermediate stage HCC (32 male, 3 female; average age, 67.5 ± 7.8 years; 22 patients Child-Pugh class A, 8 class B, 5 without cirrhosis) were treated with DEBDOX TACE. Portal vein thrombosis was observed in 6 (17.1%) patients. DEBDOX TACE was performed by superselective catheterization of feeding vessels followed by embolization with 100-300 μm microspheres loaded with 50-100 mg of doxorubicin. In all cases, CBCT was used during chemoembolization. Tumor response rates were defined according to mRECIST criteria.ResultsOverall, 120 procedures were performed (mean, 3.2 per patients). We treated 97 lesions with an average diameter of 4.9 ± 1.9 cm. There were 32 minor and 2 (1.6%) major complications (one liver abscess and one cerebrovascular insult). After a mean follow-up of 27.7 ± 10.5 months, 94.3% of patients achieved an objective response to treatment (42.4% complete response and 57.6% partial response). Mean time to progression was 10.9 ± 5.3 months. Mean overall survival was 33.9 months (95% CI; 28.9 – 38.9 months), with 1- and 2- year survival of 97.1% and 65.7%, respectively.ConclusionsSuperselective DEBDOX TACE performed under CBCT control is a safe and effective method with high rates of tumor response and overall survival.

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Multiple Ischemic Strokes after Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma with a Radiographic and Pathological Correlate

Cited by 16 publications

References 17 publications

Cerebral Lipiodol Embolism after Lymphatic Embolization for Plastic Bronchitis

Cerebral Lipiodol Embolism after Lymphatic Embolization for Plastic Bronchitis

Cerebral iodized lipid embolization via a pulmonary arteriovenous shunt: rare complication of transcatheter arterial embolization for hepatocellular carcinoma

Survival of patients with intermediate stage hepatocellular carcinoma treated with superselective transarterial chemoembolization using doxorubicin-loaded DC Bead under cone-beam computed tomography control

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