Cerebrovascular stenosis related to tyrosine kinase inhibitor for chronic myeloid leukemia: two illustrative cases
Abstract Background Tyrosine kinase inhibitors (TKIs) improve prognosis in chronic myeloid leukemia (CML). Nilotinib and ponatinib, second- and third-generation TKIs, respectively, have been reported to cause adverse vascular occlusive events such as myocardial infarction and peripheral arterial dis...
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BMC
2025-01-01
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| Online Access: | https://doi.org/10.1186/s12883-024-04006-2 |
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| author | Nozomi Sasaki Yukiko Enomoto Takamitsu Hori Hirofumi Matsubara Yusuke Egashira Tsuyoshi Izumo |
| author_facet | Nozomi Sasaki Yukiko Enomoto Takamitsu Hori Hirofumi Matsubara Yusuke Egashira Tsuyoshi Izumo |
| author_sort | Nozomi Sasaki |
| collection | DOAJ |
| description | Abstract Background Tyrosine kinase inhibitors (TKIs) improve prognosis in chronic myeloid leukemia (CML). Nilotinib and ponatinib, second- and third-generation TKIs, respectively, have been reported to cause adverse vascular occlusive events such as myocardial infarction and peripheral arterial disease. However, little is known about the risk of cerebral infarction associated with severe cerebrovascular stenosis, which is a late complication of TKIs. Herein, we report two cases of cerebrovascular stenosis associated with TKIs for CML. Case presentation A 53-year-old man with CML experienced transient right-sided hemiparesis and dysarthria. The patient had been treated with ponatinib for 5 years. Digital subtraction angiography revealed diffuse stenosis with luminal narrowing from the terminal portion of the internal carotid artery (ICA) to the entire M1 length of the middle cerebral artery (MCA). He was diagnosed with hemodynamic cerebral ischemia due to severe intracranial ICA stenosis and underwent superficial temporal artery (STA)-MCA bypass surgery. He had no atherosclerotic factors or immunological serum markers such as vasculitis. As a side effect of TKI therapy was suspected, ponatinib therapy was discontinued. A 74-year-old man treated with nilotinib for CML presented with gait disturbances. Diffusion-weighted magnetic resonance imaging revealed multiple infarctions in the right cerebral hemisphere, and magnetic resonance angiography revealed severe bilateral intracranial ICA and MCA stenosis. The patient underwent a STA-MCA bypass surgery. We discontinued nilotinib treatment. The postoperative course was uneventful. Conclusions CML prognosis has steadily improved with the advent of new TKIs. In the future, reports of cerebrovascular stenosis caused by TKIs for CML may increase and systemic complications may become a problem. We should be aware that some TKIs may cause cerebrovascular stenosis. |
| format | Article |
| id | doaj-art-84ebec21946f4158b4189dce3deeb9fd |
| institution | Kabale University |
| issn | 1471-2377 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Neurology |
| spelling | doaj-art-84ebec21946f4158b4189dce3deeb9fd2025-01-05T12:34:06ZengBMCBMC Neurology1471-23772025-01-012511810.1186/s12883-024-04006-2Cerebrovascular stenosis related to tyrosine kinase inhibitor for chronic myeloid leukemia: two illustrative casesNozomi Sasaki0Yukiko Enomoto1Takamitsu Hori2Hirofumi Matsubara3Yusuke Egashira4Tsuyoshi Izumo5Department of Neurosurgery, Gifu University Graduate School of MedicineDepartment of Neurosurgery, Gifu University Graduate School of MedicineDepartment of Neurosurgery, Gifu Prefectural General Medical CenterDepartment of Neurosurgery, Gifu University Graduate School of MedicineDepartment of Neurosurgery, Gifu University Graduate School of MedicineDepartment of Neurosurgery, Gifu University Graduate School of MedicineAbstract Background Tyrosine kinase inhibitors (TKIs) improve prognosis in chronic myeloid leukemia (CML). Nilotinib and ponatinib, second- and third-generation TKIs, respectively, have been reported to cause adverse vascular occlusive events such as myocardial infarction and peripheral arterial disease. However, little is known about the risk of cerebral infarction associated with severe cerebrovascular stenosis, which is a late complication of TKIs. Herein, we report two cases of cerebrovascular stenosis associated with TKIs for CML. Case presentation A 53-year-old man with CML experienced transient right-sided hemiparesis and dysarthria. The patient had been treated with ponatinib for 5 years. Digital subtraction angiography revealed diffuse stenosis with luminal narrowing from the terminal portion of the internal carotid artery (ICA) to the entire M1 length of the middle cerebral artery (MCA). He was diagnosed with hemodynamic cerebral ischemia due to severe intracranial ICA stenosis and underwent superficial temporal artery (STA)-MCA bypass surgery. He had no atherosclerotic factors or immunological serum markers such as vasculitis. As a side effect of TKI therapy was suspected, ponatinib therapy was discontinued. A 74-year-old man treated with nilotinib for CML presented with gait disturbances. Diffusion-weighted magnetic resonance imaging revealed multiple infarctions in the right cerebral hemisphere, and magnetic resonance angiography revealed severe bilateral intracranial ICA and MCA stenosis. The patient underwent a STA-MCA bypass surgery. We discontinued nilotinib treatment. The postoperative course was uneventful. Conclusions CML prognosis has steadily improved with the advent of new TKIs. In the future, reports of cerebrovascular stenosis caused by TKIs for CML may increase and systemic complications may become a problem. We should be aware that some TKIs may cause cerebrovascular stenosis.https://doi.org/10.1186/s12883-024-04006-2Cerebrovascular stenosisTyrosine kinase inhibitorChronic myeloid leukemiaVascular endothelial cell |
| spellingShingle | Nozomi Sasaki Yukiko Enomoto Takamitsu Hori Hirofumi Matsubara Yusuke Egashira Tsuyoshi Izumo Cerebrovascular stenosis related to tyrosine kinase inhibitor for chronic myeloid leukemia: two illustrative cases BMC Neurology Cerebrovascular stenosis Tyrosine kinase inhibitor Chronic myeloid leukemia Vascular endothelial cell |
| title | Cerebrovascular stenosis related to tyrosine kinase inhibitor for chronic myeloid leukemia: two illustrative cases |
| title_full | Cerebrovascular stenosis related to tyrosine kinase inhibitor for chronic myeloid leukemia: two illustrative cases |
| title_fullStr | Cerebrovascular stenosis related to tyrosine kinase inhibitor for chronic myeloid leukemia: two illustrative cases |
| title_full_unstemmed | Cerebrovascular stenosis related to tyrosine kinase inhibitor for chronic myeloid leukemia: two illustrative cases |
| title_short | Cerebrovascular stenosis related to tyrosine kinase inhibitor for chronic myeloid leukemia: two illustrative cases |
| title_sort | cerebrovascular stenosis related to tyrosine kinase inhibitor for chronic myeloid leukemia two illustrative cases |
| topic | Cerebrovascular stenosis Tyrosine kinase inhibitor Chronic myeloid leukemia Vascular endothelial cell |
| url | https://doi.org/10.1186/s12883-024-04006-2 |
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