Cerebral Embolism as a Rare Complication of Balloon-Occluded Retrograde Transvenous Obliteration for Gastric Varices: A Case Report

We report a case of cerebral embolism caused by balloon-occluded retrograde transvenous obliteration (BRTO) for gastric varices in a 77-year-old woman with liver cirrhosis. Balloon-occluded retrograde venography demonstrated multiple collaterals between the efferent and systemic veins, and some of them could not be embolized with metallic coils. Therefore, they were embolized with ethanol, 50% glucose solution, gelatin sponge particles, and ethanolamine oleate, and BRTO was completed. After BRTO, however, the patient complained of mild aphagia and paralysis of the right fingers, and magnetic resonance imaging demonstrated cerebral embolism. The symptoms gradually improved after the administration of ozagrel sodium and rehabilitation. The varices were also completely thrombosed. Patent foramen ovale was suspected as a cause of cerebral embolism.