Rodríguez-Santiago María A, Rodríguez-Cruz Edwin, Mesa-Pabon Marcel A
Division of Cardiology, Department of Internal Medicine, University of Puerto Rico, Medical Sciences Campus, School of Medicine, PO Box 365067, San Juan, PR 00936-5067, USA.
Cardiovascular Center of Puerto Rico and the Caribbean, PO Box 366528, San Juan, PR 00936-6528, USA.
Eur Heart J Case Rep. 2024 Oct 22;8(11):ytae565. doi: 10.1093/ehjcr/ytae565. eCollection 2024 Nov.
Totally implantable venous access devices or chemoports are progressively being used in oncologic patients for long-term chemotherapy administration. We present the case of an iatrogenic arterial catheter placement in the aortic arch complicated with multi-focal ischaemic stroke.
A case of a 73-year-old woman with a history of hypertension, diabetes mellitus, pineal gland tumour status post ventriculoperitoneal shunt, and breast and bladder cancer presented with a 2-week history of impaired balance, dysarthria, and right-sided facial drop. The chemoport was placed less than a month prior to the onset of symptoms at another institution. A brain magnetic resonance imaging revealed a left hemispheric supra- and infra-tentorial subacute ischaemic infarcts. The head and neck computed tomography angiography notably showed a misplaced venous port at the left subclavian artery with a distal tip projecting towards the ascending aortic arch, revealing the most likely aetiology of multi-focal ischaemic stroke. The patient underwent successful subclavian artery catheter extraction and endovascular repair with a suture-mediated closure device system without complications.
Subclavian artery iatrogenic cannulation may lead to catastrophic outcomes, including stroke. A high level of suspicion for venous port misplacement must be entertained when ipsilateral multi-focal ischaemic infarct occurs in time relation to catheter placement. Conducting an endovascular catheter retrieval and using a suture-mediated closure device is an alternative approach to manual compression in locations where achieving an haemostasis is challenging. A suture-mediated closure device system might be useful for anatomy not amenable to manual compression, such as the subclavian artery.
完全植入式静脉通路装置或化疗端口正逐渐用于肿瘤患者的长期化疗给药。我们报告一例医源性动脉导管误置入主动脉弓并并发多灶性缺血性卒中的病例。
一名73岁女性，有高血压、糖尿病病史，曾行脑室腹腔分流术治疗松果体瘤，患有乳腺癌和膀胱癌。患者出现平衡障碍、构音障碍和右侧面部下垂2周。化疗端口在症状出现前不到1个月于另一家机构置入。脑部磁共振成像显示左半球幕上和幕下亚急性缺血性梗死。头颈部计算机断层扫描血管造影显著显示左锁骨下动脉处静脉端口位置不当，远端尖端朝向升主动脉弓，揭示了多灶性缺血性卒中最可能的病因。患者成功进行了锁骨下动脉导管取出术，并使用缝线介导的闭合装置系统进行了血管内修复，无并发症。
锁骨下动脉医源性插管可能导致灾难性后果，包括卒中。当同侧多灶性缺血性梗死与导管置入存在时间关联时，必须高度怀疑静脉端口位置不当。在止血具有挑战性的部位，进行血管内导管取出并使用缝线介导的闭合装置是手动压迫的替代方法。缝线介导的闭合装置系统可能对不适合手动压迫的解剖部位有用，如锁骨下动脉。
