Reversible and Asymptomatic Gyral and Subarachnoid Contrast Enhancement after Carotid Stenting

Abstract

The presence of sulcal hyperdensity in patients after endovascular procedures is not necessarily attributable to hemorrhage. It may frequently indicate the absolute or concomitant extravasation of contrast material into the subarachnoid spaces.This case report describes the clinical case of an 84-year-old patient with 90% stenosis of the right internal carotid who presented with a diffuse gyral and sulcal hyperdensity in the right temporal-occipital and frontal lobes at routine post-carotid stenting (CAS) brain CT scan. The patient was asymptomatic and CT findings were interpreted as contrast enhancement hyperattenuation and no therapeutic decisions were made. A 24-hour follow-up brain CT demonstrated the complete resolution of the hyperdensity, confirming the diagnosis.In this patient we considered the concomitant presence of gyral and sulcal hyperdensity as the consequence of reversible damage to the blood-brain barrier (BBB) determining a transitory extravasation of contrast material. Asymptomatic gyral and subarachnoid contrast enhancement following CAS is generally indicative of benign and transitory damage to the BBB and is not to be misinterpreted as hemorrhage.

HARMless: Transient Cortical and Sulcal Hyperintensity on Gadolinium-Enhanced FLAIR after Elective Endovascular Coiling of Intracranial Aneurysms

“…Most data arises from the neuro-radiology literature perhaps due to greater use of MR imaging following an angiographic procedure. [1][2][3][4][5][6][7] The FLAIR sequence is known to be particularly sensitive for the detection of various pathologic processes, including subarachnoid hemorrhage, meningitis, stroke, leptomeningeal carcinomatosis, and hyperoxygenation. 6,[8][9][10][11] FLAIR can be acquired before or after gadolinium administration.…”

“…25,26 Based on the limited evidence from the literature, there is speculation for a causative relationship between CSHF and ICM exposure. Complex pathophysiologic processes during endovascular procedures such as hypoperfusion, hypoxia, ischemia, and reperfusion injury or direct neurotoxicity of the contrast agent [1][2][3][4][5]19,21,22 can result in transient injuries to the BBB.…”

Contrast extravasation after angioplasty for symptomatic stenosis of the middle cerebral artery: A case report

“…Previous studies have found that contrast extravasation after endovascular procedures may be associated with reversible BBB damage of varying degrees. 3 There are differences in the location of the brain in which extravasation has occurred. CT hyperdensities within gyri and the subarachnoid space were observed after CAS associated with hyperperfusion or haemorrhage 4,5 and within the basal ganglia and lentiform nucleus after intra-arterial thrombolysis associated with parenchymal haemorrhage.…”