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New-generation tyrosine kinase inhibitor-associated asymptomatic cerebrovascular stenosis: two illustrative cases

  • Case Report - Vascular Neurosurgery - Other
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Abstract

New-generation tyrosine kinase inhibitors (TKIs), nilotinib and ponatinib, for chronic myelogenous leukemia (CML) have been reported to cause symptomatic cerebral ischemia. Herein, we report two patients with asymptomatic cerebral artery stenosis associated with these TKIs, as a previously unreported finding. Both patients were in their 40 s and administered new-generation TKIs without vascular risk factors. New-generation TKIs for CML can cause major cerebrovascular stenosis without any symptoms. Examining the neck and intracranial arteries using magnetic resonance angiography and carotid ultrasonography may prevent future cerebral infarctions associated with these TKIs.

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Authors and Affiliations

  1. Department of Neurosurgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan

    Akihiro Hirayama, Takatoshi Sorimachi, Kazuma Yokota, Hideaki Shigematsu, Kittipong Srivatanakul & Mitsunori Matsumae

Authors
  1. Akihiro Hirayama
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  2. Takatoshi Sorimachi
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  3. Kazuma Yokota
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  4. Hideaki Shigematsu
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  5. Kittipong Srivatanakul
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  6. Mitsunori Matsumae
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Corresponding author

Correspondence to Akihiro Hirayama.

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The authors declare no competing interests.

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Comments

This is a short case report that suggests a linkage between new-generation tyrosine kinase inhibitors (TKIs), specifically nilotinib and ponatinib (used for chronic myelogenous leukemia). The authors report two patients with newly developed asymptomatic cerebral artery stenosis that they feel is perhaps associated with administration of these TKIs, which would be a previously unreported finding. Unfortunately for case #1 there is no pre-nilotinib cerebrovascular imaging data available, which weakens the hypothesis testing. Case #2 does appear to have pre- and post- drug imaging, which materially strengthens consideration of their hypothesis. The potential association is clearly worthy of further study.

Christopher Miranda Loftus

PA, USA

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Hirayama, A., Sorimachi, T., Yokota, K. et al. New-generation tyrosine kinase inhibitor-associated asymptomatic cerebrovascular stenosis: two illustrative cases. Acta Neurochir 164, 1623–1626 (2022). https://doi.org/10.1007/s00701-021-05043-3

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  • DOI: https://doi.org/10.1007/s00701-021-05043-3

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