Komatsu Toshinori, Miura Takashi, Nomoto Fumika, Itagaki Tadashi, Sunohara Daisuke, Mochidome Tomoaki, Kasai Toshio, Ikeda Uichi
Department of Cardiology, Nagano Municipal Hospital, Nagano, Japan.
Department of Cardiology, Shinshu University Hospital, Nagano, Japan.
J Cardiol Cases. 2022 Nov 10;27(2):76-79. doi: 10.1016/j.jccase.2022.10.008. eCollection 2023 Feb.
Patients with malignant diseases may develop symptoms of superior vena cava syndrome (SVCS) quickly because rapid tumor growth does not allow adequate time to develop collateral blood flow. Therefore, malignant SVCS is a medical emergency associated with neurological or pharyngeal-laryngeal signs. Recently, interventional endovascular treatment (EVT) has achieved acceptable results. We describe the case of a 55-year-old woman with pulmonary adenocarcinoma and laryngeal edema. In the first EVT, bare-metal-stent was implanted into the SVCS with intravascular ultrasound (IVUS) guidance. The IVUS showed insufficient stent-mid expansion. We did not use additional ballooning because of the risk of superior vena cava (SVC) rupture. Three months later, the SVCS recurred. A second EVT was performed, and IVUS imaging suggested tumor ingrowth into the SVC through the stent struts. We considered that the tumor ingrowth could be covered in the SVC using stent-graft. The patient showed no recurrence of SVCS for about 12 months. IVUS-guided implantation of stent for the treatment of malignant SVCS has not been reported. This case report revealed that stent therapy using IVUS for SVCS is useful.
Superior vena cava syndrome (SVCS) due to malignancy is not rare. Recently, endovascular treatment for SVCS has achieved acceptable results. However, SVC stenting in SVCS as having primary patency rate varies for each report. Intravascular ultrasound (IVUS) guided implantation of stent for malignant SVCS treatment has not been reported. In this case, we suspected insufficient stent expansion and tumor ingrowth as the possible cause of in-stent restenosis. Therefore, stent therapy using IVUS for malignant SVCS can be helpful.
恶性疾病患者可能会迅速出现上腔静脉综合征（SVCS）症状，因为肿瘤快速生长没有足够时间形成侧支血流。因此，恶性SVCS是一种伴有神经或咽喉部体征的医疗急症。近来，介入性血管内治疗（EVT）已取得了可接受的效果。我们描述了一例55岁患有肺腺癌和喉水肿的女性病例。在首次EVT中，在血管内超声（IVUS）引导下将裸金属支架植入上腔静脉。IVUS显示支架中部扩张不足。由于存在上腔静脉（SVC）破裂风险，我们未进行额外球囊扩张。三个月后，SVCS复发。进行了第二次EVT，IVUS成像提示肿瘤通过支架支柱长入SVC。我们认为可使用覆膜支架覆盖SVC内的肿瘤长入部位。该患者约12个月未出现SVCS复发。尚未有关于IVUS引导下植入支架治疗恶性SVCS的报道。本病例报告显示，IVUS引导下的支架治疗对SVCS是有用的。
恶性肿瘤导致的上腔静脉综合征（SVCS）并不罕见。近来，SVCS的血管内治疗已取得可接受的效果。然而，各报告中SVCS支架置入的初始通畅率各不相同。尚未有关于IVUS引导下植入支架治疗恶性SVCS的报道。在本病例中，我们怀疑支架扩张不足和肿瘤长入是支架内再狭窄的可能原因。因此，IVUS引导下的支架治疗对恶性SVCS可能有帮助。
