Intercostal artery pseudoaneurysm formation after irinotecan transarterial chemoembolization of a spinal metastasis from colorectal cancer - PubMed (original) (raw)

Intercostal artery pseudoaneurysm formation after irinotecan transarterial chemoembolization of a spinal metastasis from colorectal cancer

Natanel Jourabchi et al. Case Rep Radiol. 2012.

Abstract

Over the past decade, irinotecan has become one of the first-line chemotherapeutic agents used in the treatment of metastatic colorectal cancer. Recently, irinotecan has been administered transarterially in order to perform chemoembolization in the liver. In the limited number of reports available to date using this approach, serious adverse effects have not yet been reported. In this paper, we describe the formation of an intercostal artery pseudoaneurysm after transarterial chemoembolization with irinotecan-eluting beads in a patient with spinal metastasis from colorectal cancer.

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Figures

Figure 1

Figure 1

T1 post-Gadolinium fat-saturation MRI T-spine. Note the metastatic tumor in the left paravertebral/chest wall area extending into the epidural space with destruction of the left transverse processes, pedicles, and vertebral bodies. Mass measures 4.0 cm in width × 5.8 cm cephalocaudally × 4.3 cm anterior-posterior direction.

Figure 2

Figure 2

Before TACE with irinotecan-eluting beads. Selections of the (a) left T7 intercostal artery, (b) left T8 intercostal artery, and (c) left T9 intercostal artery. Note the small branches from these intercostal arteries supplying the spinal metastasis from colorectal cancer.

Figure 3

Figure 3

Left T9 intercostal artery immediately after TACE with irinotecan-eluting beads. Note that there is a small branch off of the T9 intercostal artery which still seems to supply the tumor, indicating the need to repeat the procedure in two weeks to completely chemoembolize the branch with irinotecan-eluting beads.

Figure 4

Figure 4

Two weeks after chemoembolization. Selection of the T8 intercostal artery. Note that a laterally projecting outpouching of stagnant contrast was noted, consistent with pseudoaneurysm. The opacifying portion of the pseudoaneurysm measured about 2-3 cm in size with a 5 mm neck.

Figure 5

Figure 5

Aortogram, after coil embolization of the T8 intercostal artery. Note that the postcoil embolization aortoagram demonstrates no contrast opacification of the pseudoaneurysm lumen, a coil mass measuring approximately 1.5 × 3.5 cm, and a gentle regional concave deformity of the aorta, implying that the true lumen of the pseudoaneurysm was larger than what opacified originally.

Figure 6

Figure 6

CT T-spine without contrast five months after irinotecan TACE and after pseudoaneurysm coil embolization. Note the metastatic lesion in the left paravertebral/chest wall area which has decreased in size, now measuring 5.5 cm × 5.2 cm.

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