A case of contrast-induced encephalopathy after thoracic endovascular aortic repair for a ruptured thoracic aortic aneurysm

TL;DR

A 79-year-old man developed contrast-induced encephalopathy after aortic repair surgery, highlighting the need for awareness of this rare complication.

Contribution

Reports a novel case of CIE following thoracic endovascular aortic repair, expanding understanding of its occurrence beyond typical procedures.

Findings

CIE occurred after 2-debranching TEVAR with 200 mL of contrast medium.

Conservative management led to near-complete recovery within 9 days.

CIE should be considered in delayed consciousness recovery after TEVAR in high-risk patients.

Abstract

Contrast-Induced Encephalopathy (CIE) is a rare complication, most commonly reported after carotid or coronary interventions, possibly due to reporting bias.

We present a case of CIE following two-debranching thoracic endovascular aortic repair (TEVAR). A 79-year-old man with hypertension, hyperlipidemia, stage 4 chronic kidney disease (CKD), and prior cerebral infarction underwent emergency 2-debranching TEVAR for a ruptured thoracic aortic aneurysm (TAA). A total of 200 mL of contrast medium was used pre- and intraoperatively. On postoperative day (POD) 1, the patient remained unconscious despite sedation cessation. Non-contrast brain Computed tomography (CT) showed left hemispheric cerebral edema and high-density areas suggestive of contrast extravasation, raising suspicion for CIE. Conservative management with hydration and supportive care led to gradual recovery, with imaging on POD9 showing near-complete resolution.

Although rare, CIE should be considered in cases of delayed consciousness recovery after TEVAR, particularly in high-risk patients. Early diagnosis and conservative treatment are essential for good outcomes.

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