PDF(Pubmed)
Abstract：
BACKGROUND: Trans-radial (TRA) access has become increasingly prevalent in neurointervention. Nonetheless, mediastinal hematoma after TRA is an infrequent yet grave complication associated with a notably elevated mortality rate. While our review found no reported mediastinal hematoma cases managed conservatively within neuro-interventional literature, similar complications are documented in cardiac and vascular interventional radiology, indicating its potential occurrence across disciplines.
METHODS: Carotid computed tomography angiography (CTA) showed calcified plaques with stenosis (Left: Severe, Right: Moderate) in the bilateral internal carotid arteries (ICAs) of an 81-year-old male presented with paroxysmal weakness in the right upper limb. Dual antiplatelet therapy with aspirin and clopidogrel was administered. On day 7, DSA of the bilateral ICAs was performed via TRA. Post-DSA, the patient experienced transient loss of consciousness, chest tightness, and other symptoms without ECG or MRI abnormalities. Hemoglobin level decreased from 110 g/L to 92 g/L. Iodinated contrast-induced laryngeal edema was suspected, and the patient was treated with intravenous methylprednisolone. Neck CT indicated a possible mediastinal hemorrhage, which chest CTA confirmed. The patient\'s treatment plan involved discontinuing antiplatelet medication as a precautionary measure against the potential occurrence of an ischemic stroke instead of the utilization of a covered stent graft and surgical intervention. Serial CTs revealed hematoma absorption. Discharge CT showed a reduced hematoma volume of 35 × 45 mm.
CONCLUSIONS: This case underscores the need for timely identification and precise manipulation of guidewires and guide-catheters through trans-radial access. The critical components of successful neuro-interventional techniques include timely examination, rapid identification, proper therapy, and diligent monitoring.
METHODS: Carotid computed tomography angiography (CTA) showed calcified plaques with stenosis (Left: Severe, Right: Moderate) in the bilateral internal carotid arteries (ICAs) of an 81-year-old male presented with paroxysmal weakness in the right upper limb. Dual antiplatelet therapy with aspirin and clopidogrel was administered. On day 7, DSA of the bilateral ICAs was performed via TRA. Post-DSA, the patient experienced transient loss of consciousness, chest tightness, and other symptoms without ECG or MRI abnormalities. Hemoglobin level decreased from 110 g/L to 92 g/L. Iodinated contrast-induced laryngeal edema was suspected, and the patient was treated with intravenous methylprednisolone. Neck CT indicated a possible mediastinal hemorrhage, which chest CTA confirmed. The patient\'s treatment plan involved discontinuing antiplatelet medication as a precautionary measure against the potential occurrence of an ischemic stroke instead of the utilization of a covered stent graft and surgical intervention. Serial CTs revealed hematoma absorption. Discharge CT showed a reduced hematoma volume of 35 × 45 mm.
CONCLUSIONS: This case underscores the need for timely identification and precise manipulation of guidewires and guide-catheters through trans-radial access. The critical components of successful neuro-interventional techniques include timely examination, rapid identification, proper therapy, and diligent monitoring.
摘要：
背景：经桡骨（TRA）通路在神经干预中变得越来越普遍。尽管如此，TRA后纵隔血肿是一种罕见但严重的并发症，与死亡率显着升高有关。虽然我们的评论发现，在神经介入文献中没有保守治疗的纵隔血肿病例报道，在心脏和血管介入放射学中记录了类似的并发症，表明其跨学科的潜在发生。
方法：颈动脉CT血管造影（CTA）显示钙化斑块伴狭窄（左：严重，右：81岁男性双侧颈内动脉（ICAs）中度），表现为右上肢阵发性无力。给予阿司匹林和氯吡格雷双重抗血小板治疗。在第7天,通过TRA进行双侧ICA的DSA。后DSA，病人经历了短暂的意识丧失,胸闷,和其他症状无心电图或MRI异常。血红蛋白水平从110g/L降至92g/L。怀疑碘造影剂引起的喉水肿，患者接受静脉注射甲基强的松龙治疗。颈部CT提示纵隔出血,胸部CTA证实了这一点。患者的治疗计划包括停止抗血小板药物治疗，作为预防缺血性卒中潜在发生的预防措施，而不是使用覆膜支架移植和手术干预。连续CT显示血肿吸收。出院CT显示血肿体积减少35×45mm。
结论：该案例强调了及时识别和精确操作通过经桡骨途径的导丝和导管的必要性。成功的神经介入技术的关键组成部分包括及时检查，快速识别,适当的治疗,和勤奋的监测。
方法：颈动脉CT血管造影（CTA）显示钙化斑块伴狭窄（左：严重，右：81岁男性双侧颈内动脉（ICAs）中度），表现为右上肢阵发性无力。给予阿司匹林和氯吡格雷双重抗血小板治疗。在第7天,通过TRA进行双侧ICA的DSA。后DSA，病人经历了短暂的意识丧失,胸闷,和其他症状无心电图或MRI异常。血红蛋白水平从110g/L降至92g/L。怀疑碘造影剂引起的喉水肿，患者接受静脉注射甲基强的松龙治疗。颈部CT提示纵隔出血,胸部CTA证实了这一点。患者的治疗计划包括停止抗血小板药物治疗，作为预防缺血性卒中潜在发生的预防措施，而不是使用覆膜支架移植和手术干预。连续CT显示血肿吸收。出院CT显示血肿体积减少35×45mm。
结论：该案例强调了及时识别和精确操作通过经桡骨途径的导丝和导管的必要性。成功的神经介入技术的关键组成部分包括及时检查，快速识别,适当的治疗,和勤奋的监测。
