Spinal Cord Ischemia Secondary to Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma

Abstract

Transcatheter arterial chemoembolization (TACE) is accepted worldwide as an effective treatment for patients with unresectable hepatocellular carcinoma. Although considered relatively safe, TACE has been associated with several complications. Spinal cord ischemia secondary to TACE is an extremely rare but disastrous complication. We report a very rare case of spinal cord injuries after TACE, together with a literature review. During the procedure, the patient suddenly experienced sensory impairment below the T10 dermatome and bilateral lower extremity motor weakness. She was given high-dose steroids and supportive therapy. The sensory deficits nearly improved completely, but motor strength remained unchanged. Thereafter, a chest computed tomography scan showed tumor metastasis to the lungs. The patient is now receiving sorafenib and follow-up.

Ischemic Duodenal Ulceration after Transarterial Chemoembolization for Hepatocellular Carcinoma: A Case Report

“…Tu et al [ 6 ] identified liver rupture, liver abscess, femoral arterial pseudoaneurysm, cholecystitis, biloma, and pulmonary embolism as the most common severe complications of TACE. Ischemic complications, encompassing spinal cord ischemia [ 16 ], esophageal ischemia [ 8 ], ischemic cholecystitis, and bile duct necrosis [ 17 ], as well as ischemia near the gastroduodenal arterial supply [ 7 , 8 ], are rare but can be severe and accompanied by a high mortality rate. The dominating symptoms in all cases were abdominal pain and fever that mostly occurred within 2 weeks after intervention [ 6 ].…”

“…However, the risk of complications such as partial necrosis [ 18 ], pseudocyst or abscess formation [ 21 ], and potentially fatal sepsis, especially when diagnosed at a late stage, underscores the importance of early diagnosis and differentiation from postembolic syndrome. Consequently, most authors recommend measuring lipase and/or amylase in all patients with postinterventional abdominal pain [ 16 , 18 , 19 ]. However, normal serum amylase and lipase levels in our patient with severe necrotizing pancreatitis indicate the need for radiological tools to exclude ischemic pancreatitis after TACE.…”

Spinal Cord Infarction After Chemoembolization Of Bilateral Breast Tumor: A Case Report.

“…La quimioembolización transarterial, o TACE, es un procedimiento no quirúrgico y mínimamente invasivo que consiste en combinar la administración local de quimioterapia con un procedimiento llamado embolización. Este procedimiento se puede utilizar para tratar el cáncer de mama, especialmente el de tipo metastásico (5) . Aunque se considera relativamente seguro, se ha asociado con varias complicaciones, incluida la isquemia de la médula espinal (5) .…”

“…Este procedimiento se puede utilizar para tratar el cáncer de mama, especialmente el de tipo metastásico (5) . Aunque se considera relativamente seguro, se ha asociado con varias complicaciones, incluida la isquemia de la médula espinal (5) .…”

“…La incidencia global de lesión de la médula espinal (LME) ha aumentado gradualmente, oscilando entre 13 019 y 163 420 por millón de personas. La prevalencia es de 49 024 a 52 625 por millón de personas entre los países desarrollados y 440 026 por millón de personas entre los países no desarrollados en 2017 (5) . En 2007, la incidencia de LME en Centroamérica fue de 24 por millón de habitantes y en América del Sur de 25 por millón de habitantes (6) .…”