Tyrosine Kinase Inhibitor-associated Cerebral Arterial Occlusive Disease Treated with High-flow Bypass Surgery: A Case Report

Abstract

Nilotinib, one of the tyrosine kinase inhibitors, has been used to treat chronic myeloid leukemia (CML) and Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ ALL). Nilotinibassociated cerebral arterial occlusive disease, which is treated with medicine with/without bypass surgery or stenting, has been sporadically reported to occur. The mechanism of the nilotinib-associated cerebral disease has not been clarified and is still controversial. Here we present the case of a 39-yearold woman with Ph+ ALL treated with nilotinib, which led to symptomatic intracranial arterial stenosis. We performed high-flow bypass surgery and observed the arterial stenotic change in the stenotic portion intraoperatively, whose findings strongly supported the theory of atherosclerosis and seemed to be irreversible.

Case report: Three characteristics of tyrosine kinase inhibitor-associated cerebrovascular stenosis. High threshold for infarction, atypical infarct area, and vascular recoverability under the use of ponatinib

“…In addition, the initial developments of anastomoses like moyamoya disease suggested the stenoses lasted for a significant duration, and this excluded the vasospasm. If this recoverability is widely applicable, it cautioned against recent reports recommending invasive bypass surgery or stenting for TKI-associated CVS under the assumption of irreversibility (Suzuki et al, 2019;Hirayama et al, 2022;Rai and Hara, 2023). Because of the lack of human histopathological evaluations for TKI-associated CVS, the reasons for these three differences from typical stroke remain unclear.…”