Non-ischemic cerebral enhancing lesions after intracranial aneurysm endovascular repair: a retrospective French national registry. (20th September 2021)

• Record Type: Journal Article
• 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;
• Is Part Of: Journal of neurointerventional surgery. Volume 14:Number 9(2022)
• Page Start: 925
• Page End: 930
• Publication Date: 2021-09-20
• Subjects: aneurysm -- complication -- embolic -- inflammation; Nervous system -- Surgery -- Periodicals; Cerebrovascular disease -- Surgery -- Periodicals; 617.48
• DOI: 10.1136/neurintsurg-2021-017992
• Languages: English
• ISSNs: 1759-8478

Abstract

Abstract : Background: Non-ischemic cerebral enhancing (NICE) lesions are exceptionally rare following aneurysm endovascular therapy (EVT). Objective: To investigate the presenting features and longitudinal follow-up of patients with NICE lesions following aneurysm EVT. Methods: Patients 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. Results: From 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. Conclusions: The 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.