Yamaguchi Yoshitaka, Miyata Kei, Takada Tatsuro, Tomeoka Fumiki, Ajiki Minoru
Department of Cerebrovascular Medicine, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan.
Department of Neurosurgery, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan.
J Neuroendovasc Ther. 2025;19(1). doi: 10.5797/jnet.cr.2025-0010. Epub 2025 May 20.
Submucosal esophageal hematoma (SEH) is a rare complication of neuroendovascular therapy, and there are insufficient data on the management of antithrombotic therapy in cases of SEH. We report a case of SEH following flow diverter stenting for an unruptured cerebral aneurysm, successfully managed with conservative treatment, including short-term interruption of antiplatelet therapy.
An 80-year-old woman on clopidogrel and aspirin underwent Pipeline flow diversion with adjunctive coil embolization for an unruptured right internal carotid-posterior communicating artery aneurysm under general anesthesia without complications. Postoperatively, the patient developed chest pain, and CT revealed wall thickening from the middle to lower esophagus, leading to a diagnosis of SEH. SEH in this case was likely caused by a combination of antiplatelet therapy, anticoagulants, nasogastric tube insertion, and mechanical stimulation from intubation and extubation during the operation. The patient was managed conservatively with fasting and discontinuation of antiplatelet therapy. After CT confirmed hemostasis, antiplatelet therapy was resumed with intravenous ozagrel sodium on postoperative day 3, switching to oral prasugrel on day 7. Upper gastrointestinal endoscopy (UGE) on day 8 showed the submucosal hematoma replaced by ulcers and fistula formation. UGE on day 15 showed improvement, and CT on day 23 confirmed hematoma resolution. The patient was discharged on day 24 without symptoms or complications.
In addition to previously reported cases, the presented case suggests that conservative management with temporary antiplatelet interruption and early resumption after hemostasis can lead to favorable outcomes in SEH cases associated with neuroendovascular therapy requiring antiplatelet therapy.
食管黏膜下血肿（SEH）是神经血管内治疗的一种罕见并发症，关于SEH病例中抗血栓治疗的管理数据不足。我们报告一例未破裂脑动脉瘤行血流导向支架置入术后发生SEH的病例，通过保守治疗成功处理，包括短期中断抗血小板治疗。
一名80岁正在服用氯吡格雷和阿司匹林的女性，在全身麻醉下接受了Pipeline血流导向联合弹簧圈栓塞术治疗未破裂的右侧颈内动脉-后交通动脉瘤，手术无并发症。术后，患者出现胸痛，CT显示食管中下段壁增厚，诊断为SEH。该病例中的SEH可能是抗血小板治疗、抗凝、鼻胃管插入以及手术期间插管和拔管的机械刺激共同作用的结果。患者通过禁食和停用抗血小板治疗进行保守处理。CT确认止血后，术后第3天开始静脉滴注奥扎格雷钠恢复抗血小板治疗，第7天改为口服普拉格雷。术后第8天上消化道内镜检查（UGE）显示黏膜下血肿已被溃疡和瘘管形成取代。术后第15天UGE显示病情改善，第23天CT确认血肿消退。患者于第24天出院，无任何症状或并发症。
除先前报道的病例外，本病例表明，对于与需要抗血小板治疗的神经血管内治疗相关的SEH病例，采用临时中断抗血小板治疗并在止血后早期恢复的保守管理可取得良好效果。
