Aneurysmal wall enhancement and perianeurysmal edema after endovascular treatment of unruptured cerebral aneurysms

Abstract

Our study demonstrates the prevalence and some appreciation of the natural history of aneurysmal wall enhancement and perianeurysmal brain edema following endovascular treatment of unruptured aneurysms. Aneurysmal wall enhancement is a common phenomenon while perianeurysmal edema is rare. These phenomena are likely related to the presence of inflammatory reaction near the aneurysmal wall. Both phenomena are usually asymptomatic and self-limited, and prophylactic treatment is not recommended.

Perianeurysmal vasogenic oedema (PAVO) following aneurysm embolisation: a unique case of asymptomatic long-term progression and review of the literature

“…Of the two large case series, Su et al 4 reported no statistical significance between aneurysm size and the development of PAVO in their 132 cases of 8–16 mm in size (mean 12.1 mm), whereas Lukic et al 5 report a statistically significant but clinically insignificant OR for increasing aneurysm volume and PAVO, p<0.05, OR 1.010 (95% CI 1.006 to 1.015).…”

“…The inflammatory reaction, responsible for the production of thrombus postcoiling, is hypothesised to affect the adjacent blood–brain barrier if the aneurysm wall is embedded within the brain parenchyma 4. Vasogenic oedema occurs from an increase in permeability following the disruption of the blood–brain barrier.…”

“…Su et al 4 used bare platinum coils in 84.1% of cases of unruptured aneurysms and modified platinum in the remainder (HydroCoil and Matrix). No significant difference in the incidence of PAVO was reported between coil type.…”

“…In the absence of aneurysm recanalisation, which is a known risk factor for the development of this phenomenon,2 3 the longest known time to peak PAVO formation was 6 months, and longest reported stability of oedema was 3 years 4. The majority of cases are asymptomatic 4 5…”

Intracranial vessel wall MRI: a review of current indications and future applications

“…Several studies have examined IVWM findings after endovascular treatment of IAs. Using standard MRI sequences, it has been identified that IA wall enhancement is common, occurring in 19-66 % of patients treated with endovascular coiling or flow-diversion stents [61][62][63]. Procedural factors, such as the density of coil packing or coil material and IA-specific characteristics, such as IA size or location, influenced the incidence of wall enhancement, but the MRI findings did not predict IA occlusion success, procedural complications, or post-procedure morbidity such as IA rupture.…”