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Ghouri RG, Ali MM, Naeem H, Raza MS, Arshad W. Anterior Spinal Artery Syndrome After Bronchial Embolization for Hemoptysis: A Case Report and Literature Review. BMJ Neurol Open 2024; 6:e000684. [PMID: 38800071 PMCID: PMC11116850 DOI: 10.1136/bmjno-2024-000684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2024] [Indexed: 05/29/2024] Open
Abstract
Background Bronchial artery embolization (BAE) is the established first-line treatment for patients presenting with massive haemoptysis, a life-threatening condition that can occur because of numerous underlying diseases. BAE is a relatively safe procedure with control of haemorrhage achieved in 77%-90% of cases and rare occurrence of complications. Spinal cord infarction is one such rare complication, which can have severe implications in terms of morbidity. Case presentations We present a case of a 70-year-old man who developed paraplegia with loss of pain and temperature sensation as well as sphincteric involvement following BAE for hemoptysis. MRI of the spine was suggestive of an ischaemic event involving anterolateral spinal cord segment T4-T6, so a diagnosis of anterior spinal artery syndrome post BAE was made. The patient was given corticosteroids, dual antiplatelet medications, pregabalin, supportive management and regular physiotherapy. Follow-up of the patient at 3 and 6 months failed to show any significant improvement in neurological function, although the patient did not report problem of significant hemoptysis afterward. Conclusion Spinal cord infarct is a rare and disabling complication of BAE despite it being a safe procedure with good long-term outcomes. Detailed knowledge about the anatomy of bronchial arteries and spinal arteries with detailed preprocedure investigations may lower the risk of this disabling complication.
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Affiliation(s)
- Raza Gulzar Ghouri
- Pakistan Kidney and Liver Institute and Research Center, Lahore, Pakistan
| | | | - Hamza Naeem
- King Edward Medical University, Lahore, Pakistan
| | - Maryam Saleem Raza
- Pakistan Kidney and Liver Institute and Research Center, Lahore, Pakistan
| | - Waqas Arshad
- Pakistan Kidney and Liver Institute and Research Center, Lahore, Pakistan
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Zhang Q, Li J, He G, Tang J, Zhang G. Utility of intra-procedural cone-beam computed tomography imaging for the determination of the artery of Adamkiewicz suspected by angiography during transarterial embolization for hemoptysis. Diagn Interv Radiol 2023; 29:713-718. [PMID: 36994610 PMCID: PMC10679543 DOI: 10.4274/dir.2022.221646] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 09/16/2022] [Indexed: 01/15/2023]
Abstract
PURPOSE To evaluate the role of cone-beam computed tomography (CT) performed for the determination of the artery of Adamkiewicz (AKA) suspected by angiography during trans-catheter bronchial artery embolization for hemoptysis. METHODS In this retrospective study, 17 patients with hemoptysis who underwent cone-beam CT for evaluation of the AKA prior to arterial embolization from December 2014 to March 2022 were included. During the angiographic session, two interventional radiologists selected the possible AKAs that were defined as obscured hairpin-curved vessels arising from the dorsal branch of the intercostal arteries and running towards the midline in the arterially enhanced phase. Contrast-enhanced cone-beam CT was performed as an adjunct to angiography to determine whether the indefinite AKA was a real AKA based on whether it was found to connect to the anterior spinal artery. RESULTS Selective cone-beam CT was performed at 17 possible AKAs detected by selective arteriogram of the intercostal artery (ICA). Cone-beam CT allowed for the determination of AKAs in 16 cases (94.1%). As a result of cone-beam CT findings, 9 of 16 study arteries (56.3%) were judged as definite AKAs, and the remaining 7 (43.7%) were judged as definitely not AKAs but as the musculocutaneous branching from the dorsal branch of the ICA. In 1 of 17 cases (5.9%), cone-beam CT could not determine the AKA because of poor image quality caused by inadequate breath holding. An additional anterior radiculomedullary artery arising from the dorsal branch of the lower ICA because of the inflow of the contrast medium through the anastomosis was detected in one case by conebeam CT but not by angiography. CONCLUSION Intraprocedural enhanced cone-beam CT performed as an adjunctive technique to angiography is sufficient for confident determination of the AKA, which is essential for the operators to perform accurate and safe arterial embolization for hemoptysis.
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Affiliation(s)
- Qingmeng Zhang
- Department of Emergency, Qilu Hospital of Shandong University, Shandong, China
| | - Jijun Li
- Department of Interventional Radiology, Shandong First Medical University Affiliated Provincial Hospital, Shandong, China
| | - Guanghui He
- Department of Thoracic Surgery Division of Interventional Radiology, WeiFang People’s 2nd Hospital, Shandong, China
| | - Jun Tang
- Department of Interventional Radiology, Shandong First Medical University Affiliated Provincial Hospital, Shandong, China
| | - Guodong Zhang
- Department of Interventional Radiology, Shandong First Medical University Affiliated Provincial Hospital, Shandong, China
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Kodama Y, Sakurai Y, Yamasaki K, Yokoo K. High false-negative rate of the anterior spinal artery by intercostobronchial trunk arteriography alone compared to CT during arteriography. Br J Radiol 2021; 94:20210402. [PMID: 34111972 DOI: 10.1259/bjr.20210402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES This study aimed to assess the frequencies of the anterior spinal arteries identified by CT during arteriography (CTA) and arteriography alone. METHODS This retrospective study included 137 vessels in 83 patients who performed both bronchial arteriography and CTA and categorized them into three groups based on the catheter tip locations: intercostobronchial trunk (ICBT), bronchial artery (BA), and intercostal artery (ICA). The frequencies of anterior spinal artery identified by CTA and arteriography alone were compared for each group. RESULTS ICBT, BA, and ICA groups were evaluated by CTA in 46, 79, and 12 vessels, respectively. By CTA evaluation, anterior spinal artery was identified in seven vessels (15.2%) in ICBT group, 0 in BA group and two (16.7%) in ICA group. The frequencies of anterior spinal artery were significantly higher (p < 0.05) in ICBT and ICA groups than in BA group. By arteriography evaluation alone, a faint anterior spinal artery was identified in two vessels (4.3%) in ICBT group, 0 in BA group, and 1 (8.3%) in ICA group. CONCLUSIONS Anterior spinal artery branched only from the ICBT or ICA and not from the BA in both arteriography and CTA assessments. There was high false-negative rate (71%) of the anterior spinal artery by ICBT arteriography alone assessment compared to CTA assessment. This result explains one of the reasons that spinal ischemia occurs in arteriography-negative spinal artery cases. ADVANCES IN KNOWLEDGE False-negative rate of anterior spinal artery was 71% (5/7) by intercostobronchial trunk arteriography alone assessment.
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Affiliation(s)
- Yoshihisa Kodama
- Department of Radiology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Yasuo Sakurai
- Department of Radiology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Koji Yamasaki
- Department of Radiology, Teine Keijinkai Hospital, Sapporo, Japan.,Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan
| | - Keiki Yokoo
- Department of Respiratory medicine, Teine Keijinkai Hospital, Sapporo, Japan
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Ramírez Torres M, Lastras Fernández C, Rodríguez Pardo J. Anterior medullary infarction after bronchial embolisation. NEUROLOGÍA (ENGLISH EDITION) 2021. [DOI: 10.1016/j.nrleng.2020.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Ramírez Torres M, Lastras Fernández C, Rodríguez Pardo J. [Anterior medullary infarction after bronchial embolization]. Neurologia 2020; 36:248-250. [PMID: 32651090 DOI: 10.1016/j.nrl.2020.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 02/25/2020] [Accepted: 03/20/2020] [Indexed: 10/23/2022] Open
Affiliation(s)
- M Ramírez Torres
- Servicio de Neurología, Hospital Universitario La Paz, IdiPAZ, Instituto de Investigación Sanitaria, Madrid, España.
| | - C Lastras Fernández
- Servicio de Neurología, Hospital Universitario La Paz, IdiPAZ, Instituto de Investigación Sanitaria, Madrid, España
| | - J Rodríguez Pardo
- Servicio de Neurología, Hospital Universitario La Paz, IdiPAZ, Instituto de Investigación Sanitaria, Madrid, España
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Kodama Y, Sakurai Y, Yamasaki K, Yamada G. Detection of arteriography-negative anterior spinal artery branching via intercostobronchial trunk confirmed by CT during intercostobronchial trunk arteriography: A case report. Radiol Case Rep 2020; 15:832-836. [PMID: 32346463 PMCID: PMC7183100 DOI: 10.1016/j.radcr.2020.03.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 03/23/2020] [Accepted: 03/23/2020] [Indexed: 01/21/2023] Open
Abstract
Spinal cord ischemia is an important complication of bronchial artery embolization for hemoptysis. It has been reported even though a spinal artery was not visualized on arteriography. We could show a 67-year-old man with repeated hemoptysis. His hemoptysis gradually worsened and diagnosed with severe hemoptysis, and transarterial embolization was planned to stop the hemoptysis. An anterior spinal artery arising from intercostobronchial trunk confirmed by computed tomography during arteriography even though it was not visualized on arteriography. Great care should be taken with transarterial embolization via intercostobronchial trunk, potentially branching the spinal artery, even though it was not visualized on arteriography alone.
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Affiliation(s)
- Yoshihisa Kodama
- Department of Radiology, Teine Keijinkai Hospital, 1-12-1-40 Maeda Teineku, Sapporo 006-8555, Japan
| | - Yasuo Sakurai
- Department of Radiology, Teine Keijinkai Hospital, 1-12-1-40 Maeda Teineku, Sapporo 006-8555, Japan
| | - Koji Yamasaki
- Department of Radiology, Teine Keijinkai Hospital, 1-12-1-40 Maeda Teineku, Sapporo 006-8555, Japan
| | - Gen Yamada
- Department of Respiratory Medicine, Teine Keijinkai Hospital, Sapporo 006-8555, Japan
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Saiga A, Yokota H, Higashide T, Takishima H, Omoto A, Kubota Y, Horikoshi T, Uno T. The Relationship Between Gelatin Sponge Preparation Methods and the Incidence of Intrauterine Synechia Following Uterine Artery Embolization for Postpartum Hemorrhage. Cardiovasc Intervent Radiol 2018; 42:195-204. [PMID: 30238332 DOI: 10.1007/s00270-018-2078-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 09/13/2018] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate the relationship between gelatin sponge preparation methods and the incidence of intrauterine synechia following uterine artery embolization (UAE) for postpartum hemorrhage (PPH). MATERIALS AND METHODS In a retrospective monocentric study, we used data from 20 consecutive UAE procedures (19 patients) for PPH, performed in 2007-2016, in which gelatin sponge had been used. The gelatin sponge was processed either into a slurry by pumping it back and forth about 10 times through two syringes connected to a three-way stopcock or into pledgets using a scalpel and small scissors to obtain pieces approximately 2 × 2 × 2 mm in size. Patient information was obtained from medical records, and the data were compared between patients treated with the slurry (n = 7) or pledgets (n = 13) forms. Due to the lack of follow-up data and hysterectomy after UAE, the sample size was 6 and 12 because 1 patient with 2 procedures was excluded. RESULTS The rate of intrauterine synechia was significantly higher in the slurry group (5/6, 83.3%) than that in the pledgets group (0/12, 0%; P < 0.001). In contrast, there were no significant differences in population characteristics, such as the incidence of placenta accreta, non-placental diseases, and severity of shock (DIC score, shock index, or blood loss) between the groups. CONCLUSIONS Although non-randomization and small sample size were the two main limitations, our observations suggest that UAE using gelatin sponge slurry may be associated with a high incidence of intrauterine synechia compared to UAE using pledgets.
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Affiliation(s)
- Atsushi Saiga
- Department of Radiology, Chiba University Hospital, 1-8-1, Inohana, Chuo-ku, Chiba City, Chiba, 260-8677, Japan. .,Department of Diagnostic Radiology and Radiation Oncology, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-ku, Chiba City, Chiba, 260-8670, Japan.
| | - Hajime Yokota
- Department of Radiology, Chiba University Hospital, 1-8-1, Inohana, Chuo-ku, Chiba City, Chiba, 260-8677, Japan
| | - Takashi Higashide
- Department of Radiology, Japanese Red Cross Narita Hospital, 90-1, Iida-cho, Narita City, Chiba, 286-8523, Japan
| | - Hazuki Takishima
- Department of Radiology, Chiba University Hospital, 1-8-1, Inohana, Chuo-ku, Chiba City, Chiba, 260-8677, Japan
| | - Akiko Omoto
- Department of Maternal-Fetal Medicine, Chiba University Hospital, 1-8-1, Inohana, Chuo-ku, Chiba City, Chiba, 260-8677, Japan
| | - Yoshihiro Kubota
- Department of Radiology, Chiba University Hospital, 1-8-1, Inohana, Chuo-ku, Chiba City, Chiba, 260-8677, Japan
| | - Takuro Horikoshi
- Department of Radiology, Chiba University Hospital, 1-8-1, Inohana, Chuo-ku, Chiba City, Chiba, 260-8677, Japan
| | - Takashi Uno
- Department of Radiology, Chiba University Hospital, 1-8-1, Inohana, Chuo-ku, Chiba City, Chiba, 260-8677, Japan
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Multiple Enlarged Aneurysms in Primary Racemose Hemangioma of the Bronchial Artery: Successful Prophylactic Transcatheter Arterial Embolization Using N-butyl-2-cyanoacrylate and Coils. Cardiovasc Intervent Radiol 2018; 41:811-815. [PMID: 29344717 DOI: 10.1007/s00270-018-1878-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 01/08/2018] [Indexed: 10/18/2022]
Abstract
An asymptomatic 48-year-old man presented with multiple aneurysms in a primary racemose hemangioma of the right bronchial artery. Bronchial arteriography revealed a tortuous artery with four fusiform aneurysms of varying sizes and aneurysmal dilatation with marked thrombus formation in the long segment of the distal portion. Because the tip of catheter could not pass beyond the aneurysmal dilatation, we performed balloon-occluded embolization using a mixture of N-butyl-2-cyanoacrylate (NBCA) and iodized oil. For four other aneurysms, we performed embolization using a coil alone or with NBCA. After 6 months, right bronchial arteriography revealed no enhancement of the aneurysms. Despite the rarity of this procedure, embolization with NBCA is a good option for bronchial artery aneurysm embolization.
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