A case of contrast-induced encephalopathy after thoracic endovascular aortic repair for a ruptured thoracic aortic aneurysm

BACKGROUND: Contrast-Induced Encephalopathy (CIE) is a rare complication, most commonly reported after carotid or coronary interventions, possibly due to reporting bias. CASE PRESENTATION: We present a case of CIE following two-debranching thoracic endovascular aortic repair (TEVAR). A 79-year-old man with hypertension, hyperlipidemia, stage 4 chronic kidney disease (CKD), and prior cerebral infarction underwent emergency 2-debranching TEVAR for a ruptured thoracic aortic aneurysm (TAA). A total of 200 mL of contrast medium was used pre- and intraoperatively. On postoperative day (POD) 1, the patient remained unconscious despite sedation cessation. Non-contrast brain Computed tomography (CT) showed left hemispheric cerebral edema and high-density areas suggestive of contrast extravasation, raising suspicion for CIE. Conservative management with hydration and supportive care led to gradual recovery, with imaging on POD9 showing near-complete resolution. CONCLUSIONS: Although rare, CIE should be considered in cases of delayed consciousness recovery after TEVAR, particularly in high-risk patients. Early diagnosis and conservative treatment are essential for good outcomes.