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.
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.
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