Chen Ching-Jen, Sorace Brian J, Shakeri Aria, Park Min S, Southerland Andrew M, Worrall Bradford B, Kalani M Yashar S
Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, US.
Department of Neurology, University of Virginia, Charlottesville, Virginia, US.
BMJ Case Rep. 2018 Apr 3;2018:bcr-2018-013777. doi: 10.1136/bcr-2018-013777.
Tyrosine kinase inhibitor (TKI) therapy for chronic myeloid leukemia (CML) has been associated with progressive peripheral arterial disease and, more recently, rare cases of intracranial vascular stenosis have been reported. We report the fourth case of TKI treatment associated intracranial vasculopathy and rapid progression of intracranial vascular stenosis following intracranial stent placement. This was a 49-year-old woman who developed right-sided weakness, paresthesias, numbness, and speech difficulties 7 years following TKI treatment for CML. Cerebral catheter angiography demonstrated 90% stenosis of the left supraclinoid internal carotid artery, for which the patient underwent intracranial stent placement with no residual stenosis and improved distal blood flow. Approximately 1 month following the procedure, the patient returned with similar symptoms. Catheter angiography demonstrated 70% and 50% stenosis just distal and proximal to the stent construct, respectively. Rapid disease progression and non-atherosclerotic vasculopathy may argue against endovascular therapy.
酪氨酸激酶抑制剂（TKI）治疗慢性粒细胞白血病（CML）已与进行性外周动脉疾病相关，且最近有罕见的颅内血管狭窄病例报道。我们报告了第四例与TKI治疗相关的颅内血管病变以及颅内支架置入后颅内血管狭窄快速进展的病例。这是一名49岁女性，在接受TKI治疗CML 7年后出现右侧肢体无力、感觉异常、麻木和言语困难。脑血管造影显示左侧床突上段颈内动脉狭窄90%，患者接受了颅内支架置入术，术后无残余狭窄且远端血流改善。术后约1个月，患者再次出现类似症状。导管血管造影显示支架结构远端和近端分别有70%和50%的狭窄。疾病快速进展和非动脉粥样硬化性血管病变可能不支持血管内治疗。
