Non-ischemic cerebral enhancing lesions after intracranial aneurysm endovascular repair: a retrospective French national registry

• Published in: Journal of neurointerventional surgery Vol. 14; no. 9; pp. 925 - 930
• Main Authors: Shotar, Eimad, Labeyrie, Marc-Antoine, Biondi, Alessandra, Velasco, Stéphane, Saliou, Guillaume, Boulouis, Grégoire, Daumas-Duport, Benjamin, Bourcier, Romain, Janot, Kevin, Herbreteau, Denis, Michelozzi, Caterina, Premat, Kevin, Redjem, Hocine, Bricout, Nicolas, Thouant, Pierre, Arteaga, Charles, Pierot, Laurent, Tahon, Florence, Boubagra, Kamel, Ikka, Leon, Chabert, Emmanuel, Lenck, Stéphanie, Guédon, Alexis, Consoli, Arturo, Saleme, Suzana, di Maria, Federico, Ferré, Jean-Christophe, Eugene, Francois, Anxionnat, René, Marnat, Gaultier, Guetarni, Zakaria, Sourour, Nader-Antoine, Dormont, Didier, Clarençon, Frédéric
• Format: Journal Article
• Language: English
• Published: BMA House, Tavistock Square, London, WC1H 9JR BMJ Publishing Group Ltd 01.09.2022; BMJ Publishing Group LTD; BMJ Journals
• Subjects: aneurysm; Aneurysms; Asymptomatic; Bioengineering; Biopsy; Brain damage; Carotid arteries; complication; Computer Science; Computer Vision and Pattern Recognition; embolic; Engineering Sciences; Image Processing; Imaging; inflammation; Life Sciences; Medical Imaging; Neurobiology; Neuroimaging; Neurons and Cognition; Patients; Questionnaires; Signal and Image processing; Thromboembolism; Veins & arteries; France; Complication; Inflammation; Embolic; Aneurysm
• ISSN: 1759-8478; 1759-8486; 1759-8486
• DOI: 10.1136/neurintsurg-2021-017992

BackgroundNon-ischemic cerebral enhancing (NICE) lesions are exceptionally rare following aneurysm endovascular therapy (EVT).ObjectiveTo investigate the presenting features and longitudinal follow-up of patients with NICE lesions following aneurysm EVT.MethodsPatients included in a retrospective national multicentre inception cohort were analysed. NICE lesions were defined, using MRI, as delayed onset punctate, nodular or annular foci enhancements with peri-lesion edema, distributed in the vascular territory of the aneurysm EVT, with no other confounding disease.ResultsFrom a pool of 58 815 aneurysm endovascular treatment procedures during the study sampling period (2006–2019), 21/37 centres identified 31 patients with 32 aneurysms of the anterior circulation who developed NICE lesions (mean age 45±10 years). Mean delay to diagnosis was 5±9 months, with onset occurring a month or less after the index EVT procedure in 10 out of 31 patients (32%). NICE lesions were symptomatic at time of onset in 23 of 31 patients (74%). After a mean follow-up of 25±26 months, 25 patients (81%) were asymptomatic or minimally symptomatic without disability (modified Rankin Scale (mRS) score 0–1) at last follow-up while 4 (13%) presented with mild disability (mRS score 2). Clinical follow-up data were unavailable for two patients. Follow-up MRI (available in 27 patients; mean time interval after onset of 22±22 months) demonstrated persistent enhancement in 71% of cases.ConclusionsThe clinical spectrum of NICE lesions following aneurysm EVT therapy spans a wide range of neurological symptoms. Clinical course is most commonly benign, although persistent long-term enhancement is frequent.