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Guetarni Z, Bernard R, Boulouis G, Labeyrie MA, Biondi A, Velasco S, Saliou G, Bartolini B, Daumas-Duport B, Bourcier R, Janot K, Herbreteau D, Michelozzi C, Premat K, Redjem H, Escalard S, Bricout N, Thouant P, Arteaga C, Pierot L, Tahon F, Boubagra K, Ikka L, Chabert E, Lenck S, Guédon A, Consoli A, Saleme S, Forestier G, Di Maria F, Ferré JC, Anxionnat R, Eugene F, Kerleroux B, Dargazanli C, Sourour NA, Clarençon F, Shotar E. Longitudinal radiological follow-up of individual level non-ischemic cerebral enhancing lesions following endovascular aneurysm treatment. J Neurointerv Surg 2024; 16:838-845. [PMID: 37770183 DOI: 10.1136/jnis-2023-020060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 07/07/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Non-ischemic cerebral enhancing (NICE) lesions following aneurysm endovascular therapy are exceptionally rare, with unknown longitudinal evolution. OBJECTIVE To evaluate the radiological behavior of individual NICE lesions over time. METHODS Patients included in a retrospective national multicentric inception cohort were analyzed. 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 treatment, with no other confounding disease. Lesion burden and the longitudinal behavior of individual lesions were assessed. RESULTS Twenty-two patients were included, with a median initial lesion burden of 36 (IQR 17-54) on the first MRI scan. Of the 22 patients with at least one follow-up MRI scan, 16 (73%) had new lesions occurring mainly within the first 200 weeks after the date of the procedure. The median number of new lesions per MRI was 6 (IQR 2-16). Among the same 22 patients, 7 (32%) had recurrent lesions. The median persistent enhancement of a NICE lesion was 13 weeks (IQR 6-30). No factor was predictive of early regression of enhancement activity with lesion regression kinetics mainly being patient-dependent. CONCLUSIONS The behavior of individual NICE lesions was found to be highly variable with an overall patient-dependent regression velocity.
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Affiliation(s)
- Zakaria Guetarni
- Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Remy Bernard
- Department of Neurosurgical Anesthesiology and Intensive Care, Pitié-Salpêtrière Hospital, Paris, France
| | - Grégoire Boulouis
- Department of Interventional Neuroradiology, CHU de Tours, Tours, France
| | | | - Alessandra Biondi
- Department of Interventional Neuroradiology, Besançon University Hospital, Besancon, France
| | - Stéphane Velasco
- Department of Interventional Neuroradiology, CHU de Poitiers, Poitiers, France
| | - Guillaume Saliou
- Department of Diagnostic and Interventional Radiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Vaud, Switzerland
| | - Bruno Bartolini
- Department of Diagnostic and Interventional Radiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Vaud, Switzerland
| | - Benjamin Daumas-Duport
- Department of Interventional Neuroradiology, University Hospital of Nantes, Nantes, France
| | - Romain Bourcier
- Department of Interventional Neuroradiology, University Hospital of Nantes, Nantes, France
| | - Kevin Janot
- Department of Interventional Neuroradiology, CHU de Tours, Tours, France
| | - Denis Herbreteau
- Department of Interventional Neuroradiology, CHU de Tours, Tours, France
| | - Caterina Michelozzi
- Department of Interventional Neuroradiology, Michallon Hospital, La Tronche, France
| | - Kevin Premat
- Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Hocine Redjem
- Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France
| | - Simon Escalard
- Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France
| | - Nicolas Bricout
- Department of interventional Neuroradiology, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Pierre Thouant
- Department of Neuroradiology, F Mitterand Hospital, Dijon, France
| | - Charles Arteaga
- Radiology Department, Hôpital d'Instruction des Armées Sainte-Anne Bibliothèque, Toulon, Provence-Alpes-Côte d'Azu, France
| | - Laurent Pierot
- Department of Interventional Neuroradiology, University Hospital Reims, Reims, France
| | - Florence Tahon
- Department of Neuroradiology, Grenoble Alpes University Hospital, Grenoble, France
| | - Kamel Boubagra
- Department of Neuroradiology, Grenoble Alpes University Hospital, Grenoble, France
| | - Leon Ikka
- Department of Interventional Neuroradiology, Bicetre Hospital, Le Kremlin Bicetre, France
| | - Emmanuel Chabert
- Department of Neuroradiology, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Stephanie Lenck
- Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Alexis Guédon
- Department of Interventional Neuroradiology, Hopital Lariboisiere, Paris, France
| | - Arturo Consoli
- Diagnostic and Therapeutic Neuroradiology Department, Hopital Foch, Suresnes, Île-de-France, France
| | - Suzana Saleme
- Department of Interventional Neuroradiology, Centre Hospitalier Universitaire de Limoges, Limoges, France
| | - Géraud Forestier
- Department of Interventional Neuroradiology, Centre Hospitalier Universitaire de Limoges, Limoges, France
| | - Federico Di Maria
- Diagnostic and Therapeutic Neuroradiology Department, Hopital Foch, Suresnes, Île-de-France, France
| | | | - René Anxionnat
- Department of Diagnostic and Interventional Neuroradiology, CHRU Nancy, Nancy, Lorraine, France
| | - Francois Eugene
- Department of Neuroradiology, University Hospital of Rennes, Rennes, France
| | - Basile Kerleroux
- Department of Interventional Neuroradiology, Saint Anne Hospital Centre, Paris, France
| | - Cyril Dargazanli
- Department of Neuroradiology, University Hospital Centre Montpellier, Montpellier, Occitanie, France
| | - Nader-Antoine Sourour
- Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Frédéric Clarençon
- Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Eimad Shotar
- Department of Interventional Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France
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Bayas A, Christ M, Berlis A, Naumann M, Ertl M, Joachimski F, Müller M, Welzel J, Ann Gerdes L, Seelos K, Maurer C. Incidence, clinical spectrum, and immunotherapy of non-ischemic cerebral enhancing lesions after endovascular therapy. Ther Adv Neurol Disord 2022; 15:17562864211072372. [PMID: 35126670 PMCID: PMC8808010 DOI: 10.1177/17562864211072372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/17/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Symptomatic and asymptomatic delayed non-ischemic cerebral enhancing (NICE) lesions in magnetic resonance imaging (MRI) have been reported as a rare complication after endovascular therapy (EVT) in recent years with incidence rates between 0.05% and 0.9% in most studies. Information on long-term clinical course and immunotherapies is scarce or has not been reported in detail in the literature. Objective: Aims of our study were to assess the incidence of NICE lesions in patients after cerebral EVT over a period of more than 12 years, describe clinical and EVT characteristics, and immunotherapies applied. Methods: A retrospective chart review of all patients treated by endovascular therapy for symptomatic or asymptomatic aneurysms at the University Hospital of Augsburg from May 1, 2008 to December 31, 2020 was performed. Patients were identified retrospectively and followed-up prospectively where appropriate. In addition, one case treated at another institution was included. Results: Five out of 746 patients, 0.67%, developed NICE lesions after EVT, all with non-ruptured aneurysms and all symptomatic upon detection of NICE lesions by MRI. In total, the disease course of 6 female patients is reported. Symptoms occurred after a mean time of 15 days (±13.42, SD) after EVT with headache (6/6 patients), focal neurological signs (6/6 patients), epileptic seizures (2/6 patients) and cognitive deficits (3/6 patients). All 6 patients received glucocorticosteroids (GCS), 1/6 azathioprine (AZA), 4/6 mycophenolate mofetil (MMF), 1/6 methotrexate (MTX), 1/6 rituximab (RTX), 2/6 cyclophosphamide (CYC) and 3/6 tocilizumab (TCZ). A treatment response could be observed for GCS, TCZ and MMF (in two of four cases), RTX and AZA did not result in disease stabilization. Conclusions: Delayed NICE lesions are a rare complication after EVT, requiring immunotherapies in all patients reported here. Physicians should be aware of this disorder in case of new symptoms or contrast enhancing lesions after EVT.
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Affiliation(s)
- Antonios Bayas
- Department of Neurology, University Hospital of Augsburg, Stenglinstraße 2, D-86156 Augsburg, Germany
| | - Monika Christ
- Department of Neurology, University Hospital of Augsburg, Augsburg, Germany
| | - Ansgar Berlis
- Department of Neuroradiology, University Hospital of Augsburg, Augsburg, Germany
| | - Markus Naumann
- Department of Neurology, University Hospital of Augsburg, Augsburg, Germany
| | - Michael Ertl
- Department of Neurology, University Hospital of Augsburg, Augsburg, Germany
| | - Felix Joachimski
- Department of Neuroradiology, University Hospital of Augsburg, Augsburg, Germany
| | - Mona Müller
- Department of Neurology, University Hospital of Augsburg, Augsburg, Germany
| | - Julia Welzel
- Department of Dermatology, University Hospital of Augsburg, Augsburg, Germany
| | - Lisa Ann Gerdes
- Institute of Clinical Neuroimmunology, Biomedical Center and University Hospital, LMU Munich, Munich, Germany
| | - Klaus Seelos
- Institute of Neuroradiology, University Hospital, LMU Munich, Munich, Germany
| | - Christoph Maurer
- Department of Neuroradiology, University Hospital of Augsburg, Augsburg, Germany
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