Mediastinal Hematoma as a Potential Complication of Endovascular Intracranial Intervention

Objective To highlight the rare incidence of mediastinal hematoma as a complication associated with transradial access, as reported in both cardiovascular and neurovascular fields. Interventionists must be aware of this potential risk and the strategies to manage it. Case Presentation A 66‐year‐old...

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Bibliographic Details
Main Authors: Salvador F. Gutierrez‐Aguirre, Otavio F. De Toledo, Eduarda M. Freitas, Victor H.C. Benalia, Amin Aghaebrahim, Ricardo A. Hanel, Eric Sauvageau
Format: Article
Language:English
Published: Wiley 2024-11-01
Series:Stroke: Vascular and Interventional Neurology
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Online Access:https://www.ahajournals.org/doi/10.1161/SVIN.124.001437
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Summary:Objective To highlight the rare incidence of mediastinal hematoma as a complication associated with transradial access, as reported in both cardiovascular and neurovascular fields. Interventionists must be aware of this potential risk and the strategies to manage it. Case Presentation A 66‐year‐old woman presented to an outside hospital's emergency department with 2 months of dizziness and vertigo. A right posterior communication artery aneurysm was discovered incidentally on workup images. On discussing potential options, including observation, the patient opted for endovascular intervention. The aneurysm was treated using a Woven Endobridge Single‐Layer Sphere (SLS) intrasaccular flow disrupter device. After the procedure, the patient was extubated but subsequently required reintubation because of the context of stridor. Radiologic evaluation revealed a mediastinal hematoma, which was suspected to be a direct complication from the transradial access. This required immediate treatment with coil embolization of the perforated vessel at the subclavian artery originating from the costocervical trunk. Conclusion Mediastinal hematoma is a rare complication after neurointerventional procedures by transradial access. Prompt diagnosis and appropriate treatment are critical to managing this potentially lethal condition.
ISSN:2694-5746