Enhancing brain lesions after endovascular treatment of aneurysms.

J.P Cruz,R Agid,G Saliou,M Holtmannspötter,R Willinsky,C O'Kelly,T Krings,T Marotta

doi:10.3174/ajnr.a3976

Abstract

Complications of endovascular therapy of aneurysms mainly include aneurysm rupture and thromboembolic events. The widespread use of MR imaging for follow-up of these patients revealed various nonvascular complications such as aseptic meningitis, hydrocephalus, and perianeurysmal brain edema. We present 7 patients from 5 different institutions that developed MR imaging-enhancing brain lesions after endovascular therapy of aneurysms, detected after a median time of 63 days. The number of lesions ranged from 4-46 (median of 10.5), sized 2-20 mm, and were mostly in the same vascular territory used for access. Three patients presented with symptoms attributable to these lesions. After a median follow-up of 21.5 months, the number of lesions increased in 2, was stable in 1, decreased in 3, and disappeared in 1. The imaging and clinical characteristics suggested a foreign body reaction. We could find no correlation to a specific device, but a possible source may be the generic hydrophilic coating.

Highlights

We describe a short series of nonischemic, enhancing parenchymal lesions appearing after Endovascular therapy (EVT) of intracranial aneurysms
Four patients (2 ruptured, 2 unruptured) had an early postprocedure MR; 3 showed few restricted DWI lesions in the vascular territory used for access (Fig 1) that disappeared in follow-up as expected for ischemic lesions after EVT.[12]
It is reasonable to believe that the enhancing brain lesions we describe represent an embolic phenomenon as they were restricted in all but 1 case to the vascular territory of the catheterized arteries

Summary

Introduction

1954 Cruz Oct 2014 www.ajnr.org aneurysm characteristics, procedure type, devices used, and MR characteristics of the lesions as well as the imaging and clinical findings during follow-up. Four patients (2 ruptured, 2 unruptured) had an early postprocedure MR (ie, within 7 days from the procedure); 3 showed few restricted DWI lesions in the vascular territory used for access (Fig 1) that disappeared in follow-up as expected for ischemic lesions after EVT.[12] All the other patients had the first postprocedure MR performed later as part of the routine follow-up.

Results

Conclusion