Perianeurysmal Edema Research Articles

Postembolization perianeurysmal edema as a cause of uncinate seizures

We report a patient with a giant unruptured supraclinoid aneurysm treated by endovascular embolization by means of bare coils and implantation of a flow diverterstent. Eight weeks after the embolization, she presented with uncinate seizures. Neuroradiological examination revealed de novo postembolization perianeurysmal edema, which has been described only rarely. A brief course of oral steroids successfully controlled the seizures. Perianeurysmal edema must be considered a potential complication after embolization of large aneurysms with coils and other means, and needs to be considered as a differential diagnosis in patients with unusual neurological symptoms at either the acute or delayed stages. To our knowledge, this is the first report of postembolization perianeurysmal edema occurring after successful occlusion by means of bare coils and a flow diverterstent. This report contributes to the growing evidence on adverse post-coiling inflammatory reactions, and specifically on perianeurysmal edema.

Non-invasive TOF MR angiographic follow up of coiled cerebral aneurysms

PurposeTo assess the usefulness of TOF MRA in evaluation of coil embolized cerebral aneurysms, detection of possible complications such as incomplete occlusion (residual aneurysm) and recurrence and peri-aneurysmal edema. Patients and methodsThis study included 23 patients with coil embolized cerebral aneurysm who underwent follow up by TOF MRA for 2years. Findings were classified as complete occlusion, incomplete occlusion and recurrence. Recurrent and residual cases were correlated with neurosurgical assessment. ResultsSixteen patients (69.6%) had complete persistent occlusion, 4 patients (17.4%) had recurrent aneurysms and 3 patients (13%) had residual aneurysms. Among the 7 patients of residual/recurrent aneurysms: 5 were dome and 2 were neck shaped. All recurrent cases showed peri-aneurysmal edema in the initial after coil scan. Recurrent cases were significantly correlated with initial size (more than 6mm) and presence of peri-aneurysmal edema. ConclusionMRA is a safe and accurate non-invasive follow-up imaging method that can be used for evaluation of cerebral aneurysms after embolization. It had the same accuracy of DSA. Three-dimensional TOF MRA clearly demonstrates residual/recurrent aneurysm neck and sac. MRA source images yields more information about cerebral infarction, bleeding and atrophy.

MORPHOLOGIC CHARACTERISTICS OF RETINAL ARTERIAL MACROANEURYSM AND ITS REGRESSION PATTERN ON SPECTRAL-DOMAIN OPTICAL COHERENCE TOMOGRAPHY

To investigate morphologic characteristics of retinal arterial macroaneurysm (RAM) and its regression pattern using spectral-domain optical coherence tomography. This observational case series included six eyes of six patients with RAM. All patients had undergone repeated comprehensive ophthalmologic examination, including measurement of best-corrected visual acuity, slit-lamp biomicroscopy, indirect fundus examination, fundus photography, fluorescein angiography, and spectral-domain optical coherence tomography (Spectralis OCT). Morphologic findings of RAM on spectral-domain optical coherence tomography and changes after treatment were investigated. On initial diagnosis, eyes with RAMs showed a round hyperreflective wall with a hyporeflective lumen on spectral-domain optical coherence tomography. Five of six patients underwent direct laser photocoagulation to the RAM. One hour after treatment, the lumen of the RAM showed a homogeneous high reflectance, indicating occlusion with thrombus. One or 2 months after treatment, spectral-domain optical coherence tomography demonstrated almost entirely obliterated RAMs and decreased perianeurysmal retinal edema. One patient showed spontaneous rupture and involution of RAM. Superficial location of RAM was associated with hemorrhagic complications. Spectral-domain optical coherence tomography can show morphologic characteristics of RAM and structural changes after treatment. These new findings can be valuable not only in clinical diagnosis but also in predicting the treatment response of RAM.

E-001 Partial central retinal artery occlusion following para-ophthalmic artery embolization: a case report

BackgroundCoil embolization of para-ophthalmic artery aneurysms can result in acute as well as delayed visual complications. Progressive visual changes have been have been ascribed to mass effect from aneurysm thrombosis...

Unusual Delayed Hydrocephalus After Bare Platinum Coil Embolization of an Unruptured Aneurysm -Case Report-

A 69-year-old woman developed hydrocephalus after the embolization of an incidentally detected unruptured large internal carotid artery aneurysm with bare platinum coils. Endovascular embolization resulted in near-total aneurysm occlusion. She complained of mild headache 18 hours after the procedure and magnetic resonance (MR) imaging performed on the 6(th) post-treatment day revealed wall enhancement and perianeurysmal brain edema. Follow-up MR imaging showed recanalization of the aneurysm and gradual ventricular enlargement. She presented with typical symptoms of hydrocephalus including disorientation, gait disturbance, and urine incontinence at 7 months post-embolization. We removed 30 ml of cerebrospinal fluid by lumbar tap, which improved her condition without symptom recurrence for 2 months. She did not require shunt placement. Post-interventional hydrocephalus is known in patients with unruptured aneurysms embolized with bioactive second-generation coils. This case shows that hydrocephalus can occur after aneurysm embolization with bare platinum coils without intracranial hemorrhage.

Post-embolization perianeurysmal edema revealed by temporal lobe epilepsy in a case of unruptured internal carotid artery aneurysm treated with bare platinum coils

We report the case of a patient with an unruptured internal carotid artery (ICA) aneurysm treated with bare platinum coils. The patient had seizures 1 month after treatment. Postoperative imaging showed perianeurysmal edema and enhancement of the aneurismal wall. After aneurysm coiling, perianeurysmal edema is an unusual complication that can be asymptomatic or cause symptoms depending on its location. Epilepsy as a clinical presentation of perianeurysmal edema has not previously been reported. Literature about post-embolization perianeurysmal edema is reviewed.

Long-term follow-up of endovascular coil embolization for cerebral aneurysms using three-dimensional time-of-flight magnetic resonance angiography

Objectives: As endovascular treatment becomes more prevalent, aneurysm recurrence from neck remnants, recanalization, incomplete obliteration and bleeding remain major concerns. In the current analysis, we attempted to identify factors related to disease progression and clinical outcome in patients treated with coil embolization.Methods: This study included 58 patients who underwent endovascular coil embolization for treatment of intracranial aneurysm. The result of embolization was evaluated with three-dimensional time-of-flight magnetic resonance angiography (TOF MRA) and classified as a complete occlusion, a residual neck (minor, central and marginal types), a residual dome (central and marginal types). Patients were followed up clinically and radiologically. Statistical analyses were performed to establish factors that influenced the occurrence of adverse events such as recurrence of aneurysm.Results: Overall, the complete occlusion rate was 18.8%, the occurrence of a residual neck was 67.2%, and the residual dome rate was 14.1%. The mean clinical follow-up was 31.2 months. Recurrences were found in 18 aneurysms, and major recurrences were retreated with coiling or surgery. The post-treatment study revealed that the marginal-type aneurysm filling has a significant impact on outcome. Thus, perianeurysmal edema was correlated with recurrence of the aneurysm.Conclusions: Three-dimensional TOF MRA was a sensitive tool for visualizing residual filling of embolized aneurysm and is useful for long-term follow-up of patients.

Symptomatic Perianeurysmal Edema Following Bare Platinum Embolization of a Small Unruptured Cerebral Aneurysm

There is considerable interest in the development of symptomatic inflammatory reactions following coil embolization of cerebral aneurysms. Patients have experienced a range of adverse events, usually after treatment of moderately large aneurysms with modified "bioactive" coils. More recently, it has been recognized that adverse inflammatory reactions can be associated with the use of "nonbioactive" coils, and we present a case of symptomatic perianeurysmal edema after treatment of a small unruptured aneurysm with bare platinum coils.

Minimally Conscious State After Ruptured Giant Basilar Aneurysm

To report the clinical and radiologic findings in a case of transient minimally conscious state after rupture and coiling of a giant basilar aneurysm. Case report. Neuroscience intensive care unit. A 44-year-old man who developed a transient minimally conscious state in association with perianeurysmal edema in the rostral brainstem and thalamus after rupture and coiling of a giant basilar artery aneurysm. Correlation of clinical and magnetic resonance imaging findings. A minimally conscious state and bilaterally symmetric vasogenic edema of the rostral brainstem and thalamus developed 2 days after endovascular aneurysm coiling. The clinical and radiologic abnormalities improved significantly and in parallel during the following 4 weeks. Perianeurysmal vasogenic edema in the brainstem and thalamus can develop after rupture and coiling of a giant basilar artery aneurysm. This process can be transient and can produce dramatic alterations in consciousness that later resolve.

Progressive perianeurysmal edema preceding the rupture of a small basilar artery aneurysm

We herein report the first case of progressive perianeurysmal edema preceding the rupture of a small saccular aneurysm, without any intervention or intraluminal thrombosis. A 71-year-old woman was incidentally noted to have a cerebral aneurysm (5 mm in diameter) at the lower basilar artery. Twelve months later, magnetic resonance (MR) imaging showed a T2-elongated area around a dome of the aneurysm buried in the brain stem, suggesting perianeurysmal edema formation. Interestingly, the edema progressed with the formation of a bleb, in addition to an increase in size of the aneurysm over the following 3-year period. The aneurysm eventually ruptured as a brain stem hemorrhage without any subarachnoid clots 3 days after the final check-up with MR imaging, by which a significant increase of edema formation with an increase in size of the aneurysm and a marked expansion of the bleb was observed. These findings raise the possibility that bleb formation and an enlargement of a small cerebral aneurysm might also be associated with perianeurysmal edema and a subsequent aneurysmal rupture. In addition to the pulsatile flow and/or compression from the expanded aneurysm, local inflammation in the aneurysm wall may play an important role in such edema formation.

Infected (Mycotic) Aneurysms: Spectrum of Imaging Appearances and Management

Infected aneurysms are uncommon. The aorta, peripheral arteries, cerebral arteries, and visceral arteries are involved in descending order of frequency. Staphylococcus and Streptococcus species are the most common causative pathogens. Early clinical diagnosis of infected aneurysms is challenging owing to their protean manifestations. Clinically apparent infected aneurysms are often at an advanced stage of development or are associated with complications, such as rupture. Nontreatment or delayed treatment of infected aneurysms often has a poor outcome, with high morbidity and mortality from fulminant sepsis or hemorrhage. Current state-of-the-art imaging modalities, such as multidetector computed tomography and magnetic resonance imaging, have replaced conventional angiography as minimally invasive techniques for detection of infected aneurysms in clinically suspected cases, as well as characterization of infected aneurysms and vascular mapping for treatment planning in confirmed cases. Doppler ultrasonography allows noninvasive assessment for infected aneurysms in the peripheral arteries. Imaging features of infected aneurysms include a lobulated vascular mass, an indistinct irregular arterial wall, perianeurysmal edema, and a perianeurysmal soft-tissue mass. Perianeurysmal gas, aneurysmal thrombosis, aneurysmal wall calcification, and disrupted arterial calcification at the site of the infected aneurysm are uncommon findings. Imaging-guided endovascular stent-graft repair and embolotherapy can be performed in select cases instead of open surgery. Familiarity with the imaging appearances of infected aneurysms should alert the radiologist to the diagnosis and permit timely treatment, which may include endovascular techniques.

Wall enhancement, edema, and hydrocephalus after endovascular coil occlusion of intradural cerebral aneurysms

Symptomatic local inflammation, aseptic meningitis, and hydrocephalus are reported in a group of patients treated with second generation/modified platinum coils. The purpose of this study was to define the frequency and determinants of magnetic resonance (MR) imaging findings of aneurysm wall enhancement, perianeurysmal edema, and hydrocephalus in a cohort of coil-embolized intradural cerebral aneurysms treated with bare platinum or modified platinum coils (Matrix or HydroCoils). The authors retrospectively reviewed 359 Gd-enhanced MR follow-up studies of 181 treated aneurysms (125 ruptured) for mural enhancement. Univariate and multivariate logistic regression analyses were used to define mural enhancement associations with demographic, clinical, angiographic, treatment, and follow-up data. Embolization-related edema and hydrocephalus were defined in 95 MR imaging studies of 56 unruptured aneurysms. Asymptomatic wall enhancement was observed in lesions treated with all coil types, occurring in 21 (18.6%) of 113 bare platinum coil-treated aneurysms. Independent associations were HydroCoil treatment (odds ratio [OR] 9.75, 95% confidence interval [CI] 3.45-30.75) and increasing aneurysm size (OR 3.58, 95% CI 1.99-6.95). Five (8.9%) unruptured aneurysms had asymptomatic de novo edema, and 3 (5.3%) demonstrated hydrocephalus; all had been treated with HydroCoils. Hydrocephalus presentation was delayed (8-31 months) and symptomatic in 2 patients. Asymptomatic aneurysm wall enhancement occurred in 18.6% of embolizations performed with bare platinum coils, and probably represents a normal healing response. Perimural edema and hydrocephalus were observed only in patients treated with HydroCoils, but have been reported in patients treated with other modified platinum coils. These symptoms appear to represent an exaggerated inflammatory response during aneurysm healing. Increased vigilance for delayed hydrocephalus is required. Judicious clinical use of modified platinum coils is warranted until results of randomized trials are published.

Inflammation after embolization of intracranial aneurysms

Angiographic recanalization of embolized intracranial aneurysms occurs in a significant number of patients. In recent years, different coil modifications have been introduced to decrease recanalization rates. The two main coil modifications currently available for clinical application include polyglycolic acid/polylactic acid coating to trigger a “more aggressive” inflammatory reaction (Matrix, Boston Scientific; Cerecyte, Micrus; and Nexus, MicroTherapeutics), and coating with an expandable gel to achieve a tighter packing of the aneurysm (HydroCoil, MicroVention). With the widespread introduction of these coil modifications, unexpected adverse effects have been observed in some patients, while the effectiveness of these devices in improving recanalization rates has yet to be convincingly demonstrated. In their article, Fanning and coworkers report their observations in a large cohort of patients with ruptured and unruptured intracranial aneurysms who received follow-up with magnetic resonance (MR) imaging studies after endovascular treatment. The goal of the study was to assess the degree, pattern, and course of MR imaging changes induced by coil embolization. The main findings of this study are as follows: 1) enhancement of the aneurysm wall on MR imaging was not uncommon after endovascular treatment (31.5% of patients); 2) de novo perianeurysmal edema developed in 8.9% of treated unruptured aneurysms; 3) communicating hydrocephalus occurred in 18% of unruptured aneurysms treated with HydroCoils; and 4) the observed MR imaging changes were much more common after embolization with HydroCoils. Aneurysm wall enhancement is probably a reflection of the inflammatory reaction triggered by coil embolization. Postmortem histological analysis of intracranial aneurysms treated with coil embolization demonstrates an inflammatory reaction starting at the periphery of the sac and proceeding centripetally toward the center. 1,10,13 A denser infiltration of the fibrin layer by polymorphonuclear neu

But Did You Use HydroCoil? Perianeurysmal Edema and Hydrocephalus with Bare Platinum Coils

Bioactive coils were developed to improve aneurysm packing and accelerate neointimal healing. Recent reports, however, have implicated these coils in the development of aseptic meningitis, perianeurysmal edema, and hydrocephalus. This report demonstrates that the same clinical phenomena can occur with the use of bare platinum coils.

VISUAL PATHWAY COMPROMISE AFTER HYDROCOIL TREATMENT OF LARGE OPHTHALMIC ANEURYSMS

Hydrogel-coated coils (MicroVention, Inc., Aliso Viejo, CA) for endovascular aneurysm treatment offer the theoretical advantages of increased volumetric occlusion, thrombus stabilization, and improved neointimal healing. Reports of local inflammation and hydrocephalus after coiling of unruptured aneurysms have raised questions about the safety profile or appropriate usage of these new devices. Two patients with large ophthalmic aneurysms underwent elective endovascular coiling with HydroCoils. Three to 4 weeks later, they developed profound, progressive bilateral visual loss. Magnetic resonance imaging scans demonstrated extensive enhancement of the coil ball, surrounding brain parenchyma, and optic chiasm, with perianeurysmal edema. Dexamethasone produced impressive but temporary improvement in vision in one patient; the other experienced only minor improvement. One patient also developed hydrocephalus; ventriculoperitoneal shunting reduced ventricular size but had no effect on vision. Follow-up imaging demonstrated persistent enhancement of the coil ball, as well as recurrence and extension of the abnormal signal in the parenchyma and along the optic tract. Both patients have been left with no functional vision in the eye ipsilateral to the aneurysm and have experienced marked visual field loss and reduced acuity in the contralateral eye. Ongoing international studies will provide more information on the rate of inflammatory complications. The biological mechanisms underlying the phenomenon also require investigation. Meanwhile, we caution against using HydroCoils in situations in which worsened mass effect or local inflammation would have highly deleterious consequences, such as in large aneurysms adjacent to the visual pathways or the brainstem.

Progressive perianeurysmal edema induced after endovascular coil embolization

The authors report three cases of progressive vasogenic brain edema surrounding a cerebral aneurysm after endovascular coil embolization. In all three cases embolization was incomplete due to the aneurysms' large sizes and wide necks. Follow-up magnetic resonance imaging revealed de novo vasogenic brain edema surrounding the aneurysms 3 to 6 months after the initial treatment. The edema progressed in parallel with regrowth of the aneurysms. All three aneurysms were deep in the brain parenchyma and showed intramural enhancement, suggesting hemorrhage or inflammation. Each patient underwent a second embolization for the aneurysm regrowth, which resulted in improvement of the edema. Based on the findings in these cases and review of the literature, it is suggested that incomplete occlusion of larger aneurysms that are deep within the brain may lead to a disorganized intraluminal thrombosis, aneurysm pulsing, and intramural hemorrhage or inflammation, all of which are associated with brain edema following aneurysm recanalization and regrowth. It should be kept in mind that incomplete embolization of larger aneurysms may cause such malignant change and that this complication may occur after endovascular treatment.

Mechanisms of Perianeurysmal Edema following Endovascular Embolization of Aneurysms

After coil embolization for an aneurysm, edema surrounding the aneurysm revealed by magnetic resonance imaging (MRI) is rarely seen and is usually associated with neurological symptoms. Perianeurysmal edema was found by postoperative MRI in three out of 182 patients with cerebral aneurysm, which was treated with Guglielmi Detachable Coil (GDC), and neurological symptoms developed simultaneously. In cases where neurological symptoms improved with conservative medical treatment, a temporary increase in the volume of an aneurysm, due to coil and thrombus formation, may result in edema. In cases where symptoms were not alleviated with conservative medical treatment, persistent water-hammer effect against the residual lumen of the aneurysm as well as an increase in the volume of aneurysm by hemorrhage in the aneurysmal wall may contribute to the development of perianeurysmal edema. Consideration of the mechanism of edema development by neurological symptoms, MRI findings, and angiographic findings is needed in order to select appropriate treatment.

Partially thrombosed giant intracranial aneurysms: correlation of MR and pathologic findings.

Two patients with surgically and angiographically proved partially thrombosed giant aneurysms of the middle cerebral artery were studied with computed tomography (CT) and magnetic resonance (MR) imaging. MR and histopathologic findings were correlated. The central location of methemoglobin, with its high intensity (surrounding the patent lumen, seen as signal void), in giant aneurysms is directly opposite the initial peripheral appearance of methemoglobin in extra-aneurysmal intracerebral hematomas. More peripherally, the thrombosed portion of the lumen is layered with intensities that represent stages of clot (methemoglobin and hemosiderin). Three characteristics enable differentiation of giant aneurysms from intracerebral hematoma: signal void in residual patent lumen; laminated, staged thrombus with intervening layers of hemosiderin and methemoglobin that is initially centrally, rather than only peripherally, located; and signal void in the vessel from which the aneurysm arises. Hemorrhage from prior bleeding can be readily identified and separated from perianeurysmal edema on MR images. MR appears to be a specific, noninvasive method for diagnosing partially thrombosed giant intracranial aneurysms and is superior to CT and angiography in characterizing these lesions.

Primary pulmonary cavitating carcinomas.

<h3>BACKGROUND AND PURPOSE:</h3> MR imaging findings of aneurysm enlargement, aneurysm wall enhancement, perianeurysmal edema, and embolic phenomena following deployment of flow-diverting stents may be relevant to those patients who subsequently experience procedure-related intracranial hemorrhage. We sought to document the routine early postoperative MR imaging findings following flow-diverting stent insertion. <h3>MATERIALS AND METHODS:</h3> Patients requiring flow-diverting stent placement for treatment or retreatment of cerebral aneurysms were prospectively included in the study during a 26-month period. Early postprocedural MR imaging studies were obtained and compared with preoperative imaging. Patient clinical outcome data were also collected. <h3>RESULTS:</h3> There were 34 stent-placement procedures during the study period. Aneurysm mural enhancement and mild new perianeurysmal edema were present in 50% and 14%, respectively. Any DWI lesion was present in 57% of cases. New or possibly new foci of susceptibility effect were found ipsilateral to the stent and not associated with diffusion restriction in 66% of cases. There were 2 cases (6%) of parenchymal hemorrhage and 2 major clinical complications (6%) causing permanent morbidity. <h3>CONCLUSIONS:</h3> Asymptomatic aneurysm mural enhancement is frequently seen following flow-diverting stent placement and should not necessarily be interpreted as a sign of impending aneurysm rupture. This finding often persists despite complete aneurysm occlusion. New small brain parenchymal susceptibility foci following stent placement have not previously been reported, to our knowledge, but were common in our series.