Enhancing Brain Lesions after Endovascular Treatment of Aneurysms

Cruz, Juan Pablo; Marotta, Thomas R.; O’Kelly, Cian; Holtmannspötter, Markus; Saliou, Guillaume; Willinsky, Robert A.; Krings, Timo; Agid, Ronit

doi:10.3174/ajnr.a3976

Cited by 63 publications

(62 citation statements)

References 23 publications

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“…8,10,11 Both clinical and radiographic courses were similar to those in the case series of Cruz et al 3 Our management relies on corticosteroid modulation of the inflammatory response and empiric titration of antiplatelets to balance the risks of hemorrhagic conversion and thromboembolism. Most patients report headache and/or malaise throughout the postoperative period.…”

Section: Discussionmentioning

confidence: 51%

Foreign Body Emboli following Cerebrovascular Interventions: Clinical, Radiographic, and Histopathologic Features

Shapiro¹,

Ollenschleger²,

Baccin³

et al. 2015

AJNR Am J Neuroradiol

113

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SUMMARY:Foreign material emboli following cerebral, cardiac, and peripheral catheterizations have been reported since the mid-1990s. Catheter coatings have been frequently implicated. The most recent surge of interest in this phenomenon within the neurointerventional community is associated with procedures using flow-diversion devices for the treatment of cerebral aneurysms. Following coil-supported Pipeline embolization in 4 cases and stent-supported coiling in 1, 5 patients developed multiple subcentimeter enhancing lesions, usually with surrounding edema and variable magnetic susceptibility in the vascular territories of the treated aneurysms. Conventional angiography findings were unrevealing. Laboratory work-up showed mild CSF protein elevation with no leukocytosis. Brain biopsy in 2 cases revealed granulomatous angiitis encasing foreign material, identical in stain appearance to a polyvinylpyrrolidone catheter coating. Corticosteroid administration typically produced clinical improvement. A heterogeneous radiographic and clinical course was noted, with rise and fall in the number of enhancing lesions in 2 patients and persistence in others. The etiology may be related to widespread adoption of increasingly sophisticated catheterization techniques.

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Section: Discussionmentioning

confidence: 51%

Foreign Body Emboli following Cerebrovascular Interventions: Clinical, Radiographic, and Histopathologic Features

Shapiro¹,

Ollenschleger²,

Baccin³

et al. 2015

AJNR Am J Neuroradiol

113

View full text Add to dashboard Cite

show abstract

“…The two most common serious complications of EVT are thromboembolic ischemia and intraoperative rupture [2]. A rarely reported complication after EVT is delayed nonischemic cerebral enhancing (NICE) lesions [3][4][5][6][7][8]. These lesions have most often been attributed to foreign body emboli and subsequent granulomatous reaction [3,4,6,7].…”

Section: Introductionmentioning

confidence: 98%

Non-ischemic cerebral enhancing lesions secondary to endovascular aneurysm therapy: nickel allergy or foreign body reaction? Case series and review of the literature

et al. 2016

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“…More recent articles highlight the need for this phenomenon to be considered as a potential iatrogenic cause of enhancing brain lesions [9,10].…”

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confidence: 99%

Suspected cerebral foreign body granuloma following endovascular treatment of intracranial aneurysm: imaging features

et al. 2014

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Dear Sir, Coil occlusion of aneurysms has emerged as the mainstay of treatment following the ISAT trial [1]. Advances in technology have facilitated the endovascular treatment of complex and broad necked aneurysms.These procedures often require the simultaneous placement of several pieces of equipment within the intracranial vessels for a prolonged period of time.Usually, complications after these procedures are more frequent but otherwise do not differ from simple coiling.We wish to report a rare complication in a patient after a complex procedure in tortuous anatomy.A 51-year-old woman had previously been treated at our institution after a subarachnoid haemorrhage. While the site of rupture was unknown, a proximal right A1 aneurysm and a left paraophthalmic aneurysm were both secured with bare platinum coils in one sitting.A recurrence of the A1 aneurysm was observed after 6 months and following multidisciplinary discussion, the patient consented to retreatment with stent assisted coiling using Leo + Baby low profile nitinol braided self expanding stent (Balt, Montmorency, France).The patient was pretreated with dual antiplatelets for 7 days (aspirin 75 mg OD and Clopidogrel 75 mg OD). The procedure was performed under general anaesthetic, and the patient was anticoagulated during the procedure with heparin, maintaining the activated clotting time (ACT) twice above baseline.A Fargo (Balt, Montmorency, France) distal access catheter was placed into the right internal carotid artery, and an Echelon-10 (ev3 Endovascular, Plymouth, MN, USA) was advanced into the distal right A1 over a Traxess guidewire (Microvention, Tustin, CA, USA). The placement of this equipment was difficult due to severe tortuosity of the aortic arch and supra-aortic vessels.The Leo + Baby stent was placed across the aneurysm neck in a good position. However, despite multiple attempts, the aneurysm could not be cannulated with a guidewire through the struts of the stent, and therefore, no coiling was performed.The patient was well following the procedure and was discharged 2 days later without complication.Two weeks later, the patient presented to her local hospital with two generalised seizures preceded by a prodrome of malaise, headache, and mild right sided weakness.A CT revealed several areas of cortical and white matter low attenuation within the right cerebral hemisphere. Magnetic resonance imaging of the brain demonstrated several areas of cortical and white matter T2 hyperintensity surrounding multiple lesions that exhibited nodular and peripheral rim enhancement (Fig. 1). Many of these lesions contained a central area of susceptibility artefact on gradient echo (Fig. 1b), which persisted after the resolution of oedema and contrast enhancement (Fig. 1d). The lesions were restricted to the territory of the right internal carotid artery.The patient received empirical treatment with broad spectrum antibiotics on the assumption that these lesions were infective abscesses. However, the blood inflammatory markers were not increased and bloo...

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Enhancing Brain Lesions after Endovascular Treatment of Aneurysms

Cited by 63 publications

References 23 publications

Foreign Body Emboli following Cerebrovascular Interventions: Clinical, Radiographic, and Histopathologic Features

Foreign Body Emboli following Cerebrovascular Interventions: Clinical, Radiographic, and Histopathologic Features

Non-ischemic cerebral enhancing lesions secondary to endovascular aneurysm therapy: nickel allergy or foreign body reaction? Case series and review of the literature

Suspected cerebral foreign body granuloma following endovascular treatment of intracranial aneurysm: imaging features

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