Perianeurysmal brain inflammation after flow-diversion treatment.

J. Berge, T. Tourdias, J.-F. Moreau, X. Barreau, V. Dousset
AJNR Am J Neuroradiol. 2011-09-22; 32(10): 1930-1934
DOI: 10.3174/ajnr.a2710

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1. AJNR Am J Neuroradiol. 2011 Nov-Dec;32(10):1930-4. doi: 10.3174/ajnr.A2710. Epub
2011 Sep 22.

Perianeurysmal brain inflammation after flow-diversion treatment.

Berge J(1), Tourdias T, Moreau JF, Barreau X, Dousset V.

Author information:
(1)Department of Neuroradiology, Centre Hospitalier Universitaire de Bordeaux,
Université de Bordeaux, France.

BACKGROUND AND PURPOSE: Flow-diverter stents are an alternative treatment for
challenging and recurrent aneurysms. Thrombosis of the sac is thought to induce
perianeurysmal brain inflammation, but such phenomena have never been studied in
flow-diverter devices. We developed imaging data to explain the clinical
exacerbation of symptoms after flow-diversion treatment.
MATERIALS AND METHODS: Seventeen patients with unruptured aneurysms were treated
by using a flow-diverter device. Clinical symptoms and angiographic and MR
imaging features were recorded before and after treatment, during both the acute
and chronic phases, to look for inflammatory reaction.
RESULTS: Seven of the 17 patients (41%) showed a delayed clinical aggravation of
symptoms posttreatment consisting of a headache (n = 7) with aggravation of
pre-existing compressive symptoms (n = 4) and the appearance of compressive
symptoms (n = 1). This clinical deterioration was transient; it was observed
between 3 and 15 days posttreatment and resolved by day 30. MR imaging revealed
signs highly suggestive of perianeurysmal inflammation with vasogenic edema and
blood-brain barrier breakdown. The association between MR imaging inflammatory
features and clinical aggravation was statistically significant. Large aneurysmal
size and its proximity to surrounding brain tissue were predictive of this
inflammatory reaction after flow diversion.
CONCLUSIONS: The main finding of the series is that MR imaging-defined
perianeurysmal inflammation is observed with a high frequency after treatment of
unruptured aneurysms with flow diverters and is, in most cases, associated with a
transient clinical deterioration.

DOI: 10.3174/ajnr.A2710
PMID: 21940808 [Indexed for MEDLINE]

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