Spinal cord ischemia after transcatheter artery chemoembolization for hepatocellular carcinoma: A case-report

Abstract

Introduction: Transarterial hepatic chemoembolization (TACE) has been used to treat unresectable hepatocellular carcinoma (HCC) and has gained widespread acceptance as a treatment for both primary and secondary hepatic malignancies.

Case report: We report the case of a 78-year-old male patient with chronic hepatitis B, diagnosed with HCC. He underwent a second TACE procedure, and immediately following the procedure, the patient abruptly developed bilateral lower extremity motor weakness and sensory impairment below the T10 dermatome. Spinal magnetic resonance imaging (MRI) showed increased intramedullary signal strength on T2-weighted scans at the T1-T12 level. The patient received supportive care, ongoing rehabilitation, and steroid pulse therapy. While the motor strength remained unchanged, the sensory deficiencies practically disappeared.

Clinical discussion: The hepatic artery injury or decreased blood flow at the prior TACE site, which leads to collateral recruitment, could explain why spinal cord injury following TACE typically occurs after the second or third session. In some cases, accidental embolization of spinal branches originating from intercostal or lumbar collateral arteries can occur. In this case, we hypothesize that embolism causing spinal cord infarction traveled through the connection between the lateral branches of the right inferior phrenic artery and the intercostal arteries, which supply the spinal cord through the anterior spinal artery.

Conclusions: Though rare, severe complications such as spinal cord injury can occur following TACE. A tailored therapeutic strategy, including the consideration of vascular shunts and careful selection of the vessels used for Lipiodol infusion prior to TACE, is crucial to prevent such significant consequences and achieve optimal outcomes.