Abstract
Purpose: To present the case of an initially unexplained complication of sudden pulmonary edema in a patient during stenting of the carotid artery in the interventional neurology suite.
Clinical Features: A 46-yr-old woman (ASA III) having an intracavernous carotid artery angioplasty and stenting procedure under neurolept anesthesia developed sudden pulmonary edema on completion of an otherwise uneventful stenting procedure. The patient responded well to initial management of pulmonary edema although the cause of the edema remained unclear. On retrospective examination of data and with the evolution of clinical signs it became apparent that the patient had suffered a subarachnoid hemorrhage which eventually resulted in her death.
Conclusions: Clinical signs of intracerebral events may be slow to evolve. The cause of sudden pulmonary edema in patients undergoing an interventional neuroendovascular procedure is likely to be neurogenic in origin despite the initial lack of neurological signs.
Résumé
Objectif: Présenter le cas d’une complication, d’abord inexpliquée, d’oedème pulmonaire pendant la pose d’un tuteur à l’artère carotide.
Éléments cliniques: Une femme de 46 ans (ASA III) admise pour une angioplastie du siphon carotidien et la pose d’un tuteur sous neuroleptanesthésie, a développé un oedème pulmonaire soudain à la fin de la pose du tuteur, par ailleurs sans incident. La patiente a bien réagi au traitement initial de l’œdème pulmonaire même si la cause en est restée obscure. À la suite d’un examen rétrospectif des données et de l’évolution des signes cliniques, il est devenu évident que la patiente a subi une hémorragie sous-arachnoïdienne qui a finalement causé sa mort.
Conclusion: Les signes cliniques d’événements intracérébraux peuvent présenter une lente évolution. La cause d’un œdème pulmonaire soudain chez des patients qui subissent une intervention neuroendovasculaire peut être d’origine neurogène malgré l’absence initiale de signes neurologiques.
Article PDF
Similar content being viewed by others
References
Pender ES, Pollack CV Jr. Neurogenic pulmonary edema: case reports and review. J Emerg Med 1992; 10: 45–51.
Herrick IA, Mahendran B, Penny FJ. Postobstructive pulmonary edema following anesthesia. J Clin Anesth 1990; 2: 116–20.
Lang SA, Duncan PG, Shephard DAE, Ha HC. Pulmonary oedema associated with airway obstruction. Can J Anaesth 1990; 37: 210–8.
National Institute of Neurological Disorders and Stroke. Clinical advisory: carotid endarterectomy for patients with asymptomatic internal carotid artery stenosis. (Special Report) Stroke 1994; 25: 2523–4.
Ferguson GG, Eliasziw M, Barr HWK, et al. The North American symptomatic carotid endarterectomy trial. Surgical results in 1415 patients. Stroke 1999; 30: 1751–8.
Wholey MH, Wholey M, Mathias K, et al. Global experience in cervical carotid artery stent placement. Catheter Cardiovasc Interv 2000; 50: 160–7.
Dotter CT, Judkins MP. Transluminal treatment of arteriosclerotic obstruction. Description of a new technic and a preliminary report of its application. Radiology 1989; 172: 904–20.
Grüntzig AR, Senning A, Siegenthaler WE. Nonoperative dilatation of coronary-artery stenosis. Percutaneous transluminal coronary angioplasty. N Engl J Med 1979; 301: 61–8.
Bockenheimer SAM, Mathias K. Percutaneous transluminal angioplasty in arterioscierotic internal carotid artery stenosis. AJNR Am J Neuroradiol 1983; 4: 791–2.
Hobson RW II. Status of carotid angioplasty and stenting trials. J Vasc Surg 1998; 27: 791.
Naylor AR, Bolia A, Abbott RJ, et al. Randomized study of carotid angioplasty and stenting versus carotid endarterectomy: a stopped trial. J Vasc Surg 1998; 28: 326–34.
Golledge J, Mitchell A, Greenhalgh RM, Davies AH. Systematic comparison of the early outcome of angioplasty and endarterectomy for symptomatic carotid artery disease. Stroke 2000; 31: 1439–43.
Jordan WD Jr,Schroeder PT, Fisher WS, McDowell HA. A comparison of angioplasty with stenting versus endarterectomy for the treatment of carotid artery stenosis. Ann Vasc Surg 1997; 11: 2–8.
Rosenwasser RH, Shanno GB. Angioplasty and stenting for carotid atherosclerotic disease.Neurosurg Clin N Am 2000; 11: 323–30.
Shawl F, Kadro W, Domanski MJ, et al. Safety and efficacy of elective carotid artery stenting in high-risk patients. J Am Coll Cardiol 2000; 35: 1721–8.
Andersen C, Kancir CB, Nielsen KD Laryngospasm — induced pulmonary oedema. Acta Anaesthesiol Scand 1988; 32: 710–1.
Pang W-W, Chang D-P, Lin C-H, Huang M-H. Negative pressure pulmonary oedema induced by direct suctioning of endotracheal tube adapter. Can J Anaesth 1998; 45: 785–8.
Furuhashi-Yonaha A, Dohi S, Oshima T, Ueda N. Acute pulmonary edema caused by impaired switching from nasal to oral breathing in the emergence from anesthesia (Letter). Anesthesiology 2000; 92: 1209–10.
McConkey PP. Postobstructive pulmonary oedema — a case series and review. Anaesth Intensive Care 2000; 28: 72–6.
Mayer SA, Fink ME, Homma S, et al. Cardiac injury associated with neurogenic pulmonary edema following subarachnoid hemorrhage. Neurology 1994; 44: 815–20.
L’e Orme RM, McGrath NM, Rankin RJ, Frith RW. Extracranial vertebral artery dissection presenting as neurogenic pulmonary oedema. Aust N Z J Med 1999; 29: 824–5.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Quader, K., Manninen, P.H. & Lai, J.K.T. Pulmonary edema in the neuroradiology suite: a diagnostic dilemma. Can J Anesth 48, 308–312 (2001). https://doi.org/10.1007/BF03019765
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF03019765