Oesophageal submucosal hematoma after flow diverter embolization with favourable outcome treated by discontinuing postoperative antiplatelet therapy for only three days: a case report

Abstract

Background: Oesophageal submucosal hematoma is a rare perioperative complication. When this complication develops after endovascular surgery, which requires postoperative antiplatelet therapy, whether to stop antiplatelet therapy or not is controversial. If antiplatelet therapy is discontinued, the appropriate time to resume antiplatelet therapy is unclear. Case presentation: A 75-year-old woman (height 134 cm, weight 37 kg) underwent flow diverter embolization for unruptured cerebral aneurysm under general anaesthesia. The patient received dual antiplatelet therapy before surgery and anticoagulation therapy intraoperatively. After surgery, the patient developed hematemesis and was diagnosed with oesophageal submucosal hematoma. Conservative treatment was initiated after discontinuing antiplatelet therapy, which was resumed 3 days after surgery. The patient showed good recovery even after the resumption of antiplatelet therapy. Conclusions: In our case, we successfully treated oesophageal submucosal hematoma developing after endovascular surgery with early resumption of postoperative antiplatelet therapy.

Clinical Results of Flow Diverter Treatments for Cerebral Aneurysms under Local Anesthesia

“…Similar to other neuroendovascular procedures, FD placement is performed under GA for patient comfort, control of hemodynamics and respiration, and better image quality because of the decreased motion artifacts in immobile patients [ 4 ]. However, GA using an endotracheal tube is not risk-free and can cause a range of airway injuries, including hoarseness, vocal cord paralysis, tracheomalacia, and esophageal submucosal hematoma [ 26 , 27 ]. The incidence of airway complications caused by endotracheal intubation ranges from 0.5 to 7% [ 26 ].…”