Patients with Intracranial Aneurysms Immediate Postembolization CT Scans of Focal Increased Cortical Density in

BACKGROUND AND PURPOSE: Cortical hyperdensity was observed in the immediate postembolization CT scans of some patients with intracranial aneurysms following uneventful endovascular treatments. The clinical significance and possible underlying mechanism were evaluated. MATERIAL AND METHODS: Ninety-three consecutive patients with a total of 100 intracranial aneurysms, treated by endosaccular packing, were studied. Seventy-four aneurysms were treated with balloon assistance, and the remaining aneurysms were treated without balloon assistance. All patients underwent cranial CT just before and immediately after the endovascular treatment. If the post-treatment CT showed any new finding, an immediate MR imaging and a repeat CT 4–6 hours after the initial posttreatment CT were performed. Several parameters were investigated related to the presence of cortical hyperdensity. RESULTS: Cranial CT showed focal cortical hyperdensity following the treatment of 40/74 aneurysms (54%) with balloon remodeling and 9/26 aneurysms (34.6%) without balloon assistance. None of these patients were symptomatic, and cortical hyperdensity resolved in the repeat CT scans. A statistically significant relationship was observed between the presence of this finding and the total amount of contrast material, microcatheter time, number of balloon inflations, and total balloon inflation time. CONCLUSION: Immediate postembolization CT may show focal cortical hyperdensity following un-eventful endovascular aneurysm treatment, most likely caused by blood-brain barrier disruption resulting in accumulation of contrast medium. The hyperdensity was more frequent when balloon assistance was used but was also seen in the patients with no balloon use. It is important to differentiate this clinically insignificant finding from possible hemorrhage, which would affect patients’ immediate postprocedural medical management.

[1]  I. Saatci,et al.  Late angiographic and clinical follow-up results of 100 consecutive aneurysms treated with Onyx reconstruction: largest single-center experience , 2006, Neuroradiology.

[2]  P. Stieg,et al.  Advances in endovascular aneurysm treatment: are we making a difference? , 2005, Neuroradiology.

[3]  Elad Levy,et al.  Periprocedural morbidity and mortality associated with endovascular treatment of intracranial aneurysms. , 2005, AJNR. American journal of neuroradiology.

[4]  M. Cusimano,et al.  Microstent-Assisted Coiling for Wide-Necked Intracranial Aneurysms , 2005, Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques.

[5]  N. Kocer,et al.  Thromboembolic events associated with balloon-assisted coil embolization: evaluation with diffusion-weighted MR imaging. , 2004, AJNR. American journal of neuroradiology.

[6]  M. Hirohata,et al.  Blood brain-barrier disruption of nonionic iodinated contrast medium following coil embolization of a ruptured intracerebral aneurysm. , 2004, AJNR. American journal of neuroradiology.

[7]  R. Rosenwasser,et al.  ENDOVASCULAR OCCLUSION OF WIDE-NECKED ANEURYSMS WITH A NEW INTRACRANIAL MICROSTENT (NEUROFORM) AND DETACHABLE COILS , 2004, Neurosurgery.

[8]  G. Duckwiler,et al.  Treatment of unruptured aneurysms with GDCs: clinical experience with 247 aneurysms. , 2004, AJNR. American journal of neuroradiology.

[9]  P. Flandroy,et al.  Endovascular treatment of intracranial wide-necked aneurysms using three-dimensional coils: predictors of immediate anatomic and clinical results. , 2004, AJNR. American journal of neuroradiology.

[10]  N. Yamada,et al.  Thromboembolic events associated with Guglielmi detachable coil embolization with use of diffusion-weighted MR imaging. Part II. Detection of the microemboli proximal to cerebral aneurysm. , 2003, AJNR. American journal of neuroradiology.

[11]  G. Rinkel,et al.  Treatment of ruptured intracranial aneurysms: implications of the ISAT on clipping versus coiling. , 2003, European journal of radiology.

[12]  G. Hamann,et al.  Nonionic Contrast Neurotoxicity after Coronary Angiography Mimicking Subarachnoid Hemorrhage , 2003, European Neurology.

[13]  Yuichi Murayama,et al.  Guglielmi detachable coil embolization of cerebral aneurysms: 11 years' experience. , 2003, Journal of neurosurgery.

[14]  R. Vanninen,et al.  Broad-based intracranial aneurysms: thrombosis induced by stent placement. , 2003, AJNR. American journal of neuroradiology.

[15]  D. Kallmes,et al.  Cerebral aneurysm perforations complicating therapy with Guglielmi detachable coils: a meta-analysis. , 2002, AJNR. American journal of neuroradiology.

[16]  A. Molyneux International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial , 2002, The Lancet.

[17]  H. Zeumer,et al.  Outcome after endovascular therapy of ruptured intracranial aneurysms: morbidity and impact of rebleeding , 2002, Neuroradiology.

[18]  D. Roy,et al.  Neck-bridge device for endovascular treatment of wide-neck bifurcation aneurysms: initial experience. , 2001, Radiology.

[19]  T. Jaspan,et al.  Delayed reconfiguration of a Guglielmi detachable coil mass associated with late occlusion of an adjacent aneurysm and parent vessel. , 2000, AJNR. American journal of neuroradiology.

[20]  A. Luft,et al.  Prevention and treatment of thromboembolic and ischemic complications associated with endovascular procedures: Part II--Clinical aspects and recommendations. , 2000, Neurosurgery.

[21]  J. Dion,et al.  Endovascular treatment of intracranial aneurysms with Guglielmi Detachable Coils: emphasis on new techniques , 2000, Journal of Clinical Neuroscience.

[22]  I. Wilkinson,et al.  Unilateral leptomeningeal enhancement after carotid stent insertion detected by magnetic resonance imaging. , 2000, Stroke.

[23]  G Marchal,et al.  Early Postischemic Hyperperfusion: Pathophysiologic Insights from Positron Emission Tomography , 1999, Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism.

[24]  A. Molyneux,et al.  Five-year experience in using coil embolization for ruptured intracranial aneurysms: outcomes and incidence of late rebleeding. , 1999, Journal of neurosurgery.

[25]  L. Monsein,et al.  Subarachnoid contrast enhancement after spinal angiography mimicking diffuse subarachnoid hemorrhage. , 1998, AJR. American journal of roentgenology.

[26]  G. Duckwiler,et al.  Guglielmi detachable coil embolization of acute intracranial aneurysm: perioperative anatomical and clinical outcome in 403 patients. , 1997, Journal of neurosurgery.

[27]  J. Baron,et al.  Relationships between High Oxygen Extraction Fraction in the Acute Stage and Final Infarction in Reversible Middle Cerebral Artery Occlusion: An Investigation in Anesthetized Baboons with Positron Emission Tomography , 1996, Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism.

[28]  F. Powell,et al.  Unilateral cerebral cortical and basal ganglia enhancement following overdosage of nonionic contrast media. , 1995, Computerized medical imaging and graphics : the official journal of the Computerized Medical Imaging Society.

[29]  Alan J. Wilson,et al.  The blood-brain barrier: an important concept in neuroimaging. , 1994, AJNR. American journal of neuroradiology.

[30]  B. V. Van Beers,et al.  Cortical and CSF hyperdensity after iodinated contrast medium overdose: CT findings. , 1992, Journal of computer assisted tomography.

[31]  S. Takebayashi,et al.  Disruption of the blood-brain barrier caused by nonionic contrast medium used for abdominal angiography: CT demonstration. , 1989, Journal of computer assisted tomography.

[32]  A. Mooradian Effect of aging on the blood-brain barrier , 1988, Neurobiology of Aging.

[33]  N. Lassen,et al.  The luxury-perfusion syndrome and its possible relation to acute metabolic acidosis localised within the brain. , 1966, Lancet.

[34]  J. Cervós-Navarro,et al.  Blood-brain barrier permeability to micromolecules and edema formation in the early phase of incomplete continuous ischemia , 2004, Acta Neuropathologica.

[35]  A. Norbash,et al.  Silent thromboembolic events associated with the treatment of unruptured cerebral aneurysms by use of Guglielmi detachable coils: prospective study applying diffusion-weighted imaging. , 2001, AJNR. American journal of neuroradiology.

[36]  R. Macdonald,et al.  Etiology of cerebral vasospasm. , 1999, Acta neurochirurgica. Supplement.