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Tyrosine kinase inhibitor-associated cerebral vasculopathy with a distinct non-enhancing vessel wall phenotype: a
Jeong Eun Yang1, Jae Ho Jeon1, Young Rok Do2
1Department of Neurology, Dong-san Hospital, Keimyung University School of Medicine, Daegu, Korea.
Background:
Tyrosine kinase inhibitors (TKIs) are associated with adverse vascular events, including cerebrovascular stenosis. However, most reported cases rely on luminal imaging, and the arterial wall characteristics of TKI-associated vasculopathy remain insufficiently characterized.
Case Presentation:
A 47-year-old man with chronic myeloid leukemia developed recurrent transient ischemic attacks during long-term exposure to multiple tyrosine kinase inhibitors, including sequential treatment with nilotinib and ponatinib. Neurovascular imaging revealed extensive multifocal steno-occlusive lesions involving both intracranial and extracranial arteries, accompanied by severe hemodynamic compromise. High-resolution vessel wall MRI demonstrated diffuse circumferential wall thickening with negative remodeling in both distal internal carotid arteries and eccentric thickening along the anterior walls of the bilateral M1 segments of the middle cerebral artery. Notably, no definite mural enhancement was observed. Following discontinuation of ponatinib and transition to alternative therapy, cerebral perfusion improved at two months, and the patient remained clinically stable without recurrent ischemic events.
Conclusions:
This case illustrates a potentially distinct vessel wall thickening pattern in TKI-associated vasculopathy, providing information beyond luminal stenosis. The absence of definite mural enhancement and clinical and hemodynamic improvement after treatment modification suggest a drug-related vascular component. Vessel wall imaging may aid in the evaluation of this condition and inform management strategies.
Insights
Tyrosine kinase inhibitor (TKI) vasculopathy may present with distinct arterial wall thickening, not just stenosis. Vessel wall imaging and treatment modification improved outcomes in a patient with chronic myeloid leukemia.
Area of Science:
- Neurology
- Oncology
- Radiology
Background:
- Tyrosine kinase inhibitors (TKIs) are linked to vascular events like cerebrovascular stenosis.
- Arterial wall characteristics in TKI-associated vasculopathy are not well understood, as most studies use luminal imaging.
Purpose of the Study:
- To describe the arterial wall characteristics in a patient with TKI-associated vasculopathy.
- To highlight the utility of vessel wall imaging in diagnosing and managing this condition.
Main Methods:
- A case report of a 47-year-old man with chronic myeloid leukemia on TKIs (nilotinib, ponatinib) experiencing transient ischemic attacks.
- Neurovascular imaging, including high-resolution vessel wall MRI, was used to evaluate extensive steno-occlusive lesions.
- Treatment was modified by discontinuing ponatinib and switching to alternative therapy.
Main Results:
- The patient presented with multifocal intracranial and extracranial arterial stenosis and hemodynamic compromise.
- High-resolution vessel wall MRI revealed diffuse circumferential and eccentric wall thickening without definite mural enhancement.
- Following treatment modification, cerebral perfusion improved, and the patient remained clinically stable without recurrent ischemic events.
Conclusions:
- This case suggests a unique vessel wall thickening pattern in TKI-associated vasculopathy.
- The findings indicate a potential drug-related vascular process, supported by the lack of mural enhancement and improvement after treatment change.
- Vessel wall imaging is valuable for evaluating TKI-associated vasculopathy and guiding management.
