[Cerebrovascular accidents after endoscopic obturation of esophageal varices with isobutyl-2-cyanoacrylate in 2 patients].
We report 2 cases of cerebral stroke in cirrhotic patients following endoscopic obturation of esophageal varices with Isobutyl-2-Cyanoacrylate. In both cases, hemiplegia appeared several hours after the procedure. A brain CT scan showed radiodense material in the cerebral arteries due to dissemination of Isobutyl-2-Cyanoacrylate. One patient died, the other improved slowly. Different hypotheses may be raised: defectuous injection into the arterial circulation, systemic emboli via portopulmonary venous shunts, delayed polymerization of Isobutyl-2-Cyanoacrylate. Systemic emboli have been reported previously following percutaneous transhepatic obliteration of esophageal varices, suggesting portopulmonary venous shunts. In spite of these 2 complications, this procedure remains useful in stopping acute variceal bleeding and in preventing recurrent bleeding.
D002015:Bucrylate / Q000009:adverse effects*; D003487:Cyanoacrylates / Q000009:adverse effects*; D004621:Embolization, Therapeutic / Q000009:adverse effects*; D004932:Esophageal and Gastric Varices / Q000628:therapy*; D004945:Esophagoscopy; D005260:Female; D006429:Hemiplegia / Q000209:etiology; D006801:Humans; D002542:Intracranial Embolism and Thrombosis / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011652:Pulmonary Circulation
D003487:Cyanoacrylates; D002015:Bucrylate
Accidents vasculaires cérébraux après obturation endoscopique des varices oesophagiennes par l'isobutyl-2-cyanoacrylate chez deux malades.