CEREBRAL INFARCTION FOLLOWING ENDOSCOPIC OBLITERATION OF ESOPHAGEAL-VARICES USING ISOBUTYL-2-CYANOACRYLATE - REPORT OF 2 CASES

  • 1 August 1986
    • journal article
    • research article
    • Vol. 10  (8-9) , 604-607
Abstract
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: (a) defectuous injection into the arterial circulation, (b) systemic emboli via portopulmonary venous shunts, (c) 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.