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Original research
Non-ischemic cerebral enhancing lesions after intracranial aneurysm endovascular repair: a retrospective French national registry
  1. Eimad Shotar1,
  2. Marc-Antoine Labeyrie2,
  3. Alessandra Biondi3,
  4. Stéphane Velasco4,
  5. Guillaume Saliou5,6,
  6. Grégoire Boulouis7,8,
  7. Benjamin Daumas-Duport9,
  8. Romain Bourcier9,
  9. Kevin Janot7,
  10. Denis Herbreteau7,
  11. Caterina Michelozzi10,
  12. Kevin Premat1,
  13. Hocine Redjem11,
  14. Nicolas Bricout12,
  15. Pierre Thouant13,
  16. Charles Arteaga14,
  17. Laurent Pierot15,
  18. Florence Tahon16,
  19. Kamel Boubagra16,
  20. Leon Ikka17,
  21. Emmanuel Chabert18,
  22. Stéphanie Lenck1,
  23. Alexis Guédon2,19,
  24. Arturo Consoli19,
  25. Suzana Saleme20,
  26. Federico di Maria19,
  27. Jean-Christophe Ferré21,
  28. Francois Eugene21,
  29. René Anxionnat22,23,
  30. Gaultier Marnat24,
  31. Zakaria Guetarni1,
  32. Nader-Antoine Sourour1,
  33. Didier Dormont1,25,
  34. Frédéric Clarençon1,25
  1. 1 Department of Neuroradiology, Pitié Salpêtrière Hospital, Paris, France
  2. 2 Department of Interventional Neuroradiology, Lariboisière Hospital, Paris, France
  3. 3 Department of Neuroradiology and Endovascular Therapy, Besançon University Hospital, Besancon, France
  4. 4 Interventional Neuroradiology Department, Poitiers University Hospital, Poitiers, France
  5. 5 Department of Diagnostic and Interventional Radiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Vaud, Switzerland
  6. 6 Faculty of Medicine, UNIL, Lausanne, Switzerland
  7. 7 Department of Interventional Neuroradiology, Bretonneau Hospital, Tours, France
  8. 8 Interventional Neuroradiology Department, Sainte Anne Hospital, Paris, France
  9. 9 Department of Neuroradiology, CHU de Nantes, Nantes, France
  10. 10 Department of Neuroradiology, Michallon Hospital, Toulouse, France
  11. 11 Department of Interventional Neuroradiology, Fondation Rothschild Hospital, Paris, France
  12. 12 Department of interventional Neuroradiology, Centre Hospitalier Regional Universitaire de Lille, Lille, France
  13. 13 Department of Neuroradiology, F Mitterand Hospital, Dijon, France
  14. 14 Hôpital d'Instruction des Armées Sainte-Anne Bibliothèque, Toulon, Provence-Alpes-Côte d'Azu, France
  15. 15 Department of Radiology, University Hospital Reims, Reims, France
  16. 16 Neuroradiology Department, Grenoble University Hospital, Grenoble, France
  17. 17 Department of Interventional Neuroradiology, Kremlin Bicetre University Hospital, Kremlin Bicetre, France
  18. 18 Department of Neuroradiology, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
  19. 19 Department of Diagnostic and Therapeutic Neuroradiology, Foch Hospital, Suresnes, France
  20. 20 Department of Interventional Neuroradiology, CHU Limoges, Limoges, France
  21. 21 Department of Neuroradiology, University Hospital of Rennes, Rennes, France
  22. 22 Department of Diagnostic and Interventional Neuroradiology, CHRU Nancy, Nancy, Lorraine, France
  23. 23 Université de Lorraine, Faculté de Médecine, Vandœuvre-lès-Nancy, Lorraine, France
  24. 24 Department of Interventional and Diagnostic Neuroradiology, Bordeaux University Hospital, Bordeaux, France
  25. 25 Sorbonne Université, Paris, France
  1. Correspondence to Dr Eimad Shotar, Department of Neuroradiology, University Hospital Pitié Salpêtrière, Paris, Île-de-France, France; eimad.shotar{at}


Background Non-ischemic cerebral enhancing (NICE) lesions are exceptionally rare following aneurysm endovascular therapy (EVT).

Objective To investigate the presenting features and longitudinal follow-up of patients with NICE lesions following aneurysm EVT.

Methods Patients included in a retrospective national multicentre inception cohort were analysed. 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 EVT, with no other confounding disease.

Results From a pool of 58 815 aneurysm endovascular treatment procedures during the study sampling period (2006–2019), 21/37 centres identified 31 patients with 32 aneurysms of the anterior circulation who developed NICE lesions (mean age 45±10 years). Mean delay to diagnosis was 5±9 months, with onset occurring a month or less after the index EVT procedure in 10 out of 31 patients (32%). NICE lesions were symptomatic at time of onset in 23 of 31 patients (74%). After a mean follow-up of 25±26 months, 25 patients (81%) were asymptomatic or minimally symptomatic without disability (modified Rankin Scale (mRS) score 0–1) at last follow-up while 4 (13%) presented with mild disability (mRS score 2). Clinical follow-up data were unavailable for two patients. Follow-up MRI (available in 27 patients; mean time interval after onset of 22±22 months) demonstrated persistent enhancement in 71% of cases.

Conclusions The clinical spectrum of NICE lesions following aneurysm EVT therapy spans a wide range of neurological symptoms. Clinical course is most commonly benign, although persistent long-term enhancement is frequent.

  • aneurysm
  • complication
  • embolic
  • inflammation

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • Contributors ES, FC: study design; all co-authors: data collection; ES: data analysis ES: writing manuscript; all co-authors: critical review of the manuscript; al co-authors: final approval of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests AB reports conflicts of interest with Balt, Cerus Endovascular, Medtronic, Microvention, Penumbra, and Stryker Neurovascular. FC reports conflict of interest with Medtronic, Guerbet, Balt Extrusion (payment for readings), and Codman Neurovascular (core laboratory). N-AS is consultant for Medtronic, Balt Extrusion, and Microvention. GM reports conflicts of interest with Medtronic and Microvention. LP reports conflicts of interest with Balt, Microvention, Phenox, and Perflow. EC reports participation on the Data Safety Monitoring Board of the Atlas stent study. The other authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. The manuscript is not supported by industry.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.