Contrast-induced encephalopathy following endovascular treatment for intracranial aneurysms—risk factors analysis and clinical strategy

• Published in: Neuroradiology Vol. 65; no. 3; pp. 629 - 635
• Main Authors: Li, Mengxing, Liu, Jian, Chen, Feng, Fan, Chengzhe, Yang, Xinjian, Sun, Xuan
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.03.2023; Springer Nature B.V
• Subjects: Abnormalities; Aneurysm; Aneurysms; Cardiovascular system; Computed tomography; Contrast agents; Contrast Media; Disorientation; Dosage; Edema; Embolization, Therapeutic - methods; Encephalopathy; Health services; Hemiplegia; Humans; Hypertension; Hypertension - complications; Imaging; Interventional Neuroradiology; Intracranial Aneurysm - therapy; Intracranial pressure; Medicine; Medicine & Public Health; Neurological diseases; Neurology; Neuroradiology; Neurosciences; Neurosurgery; Paralysis; Patients; Radiology; Regression analysis; Retrospective Studies; Risk analysis; Risk Factors; Signs and symptoms; Strategy; Stroke; Stroke - etiology; Therapy; Treatment Outcome; Vasoconstriction; Contrast-induced encephalopathy; Endovascular treatment; Intracranial aneurysm; Risk factors analysis
• ISSN: 0028-3940; 1432-1920; 1432-1920
• DOI: 10.1007/s00234-022-03077-7

Purpose Contrast-induced encephalopathy (CIE) was defined as new onset of neurological deficits after exposure to contrast media, which could be observed after the endovascular treatment for intracranial aneurysms. Methods We enrolled a consecutive cohort of patients who underwent endovascular treatment for unruptured intracranial aneurysms. CIE was defined as a reversible neuropathic syndrome that occurred after interventional therapy, accompanied by imaging abnormalities and excluding other diseases. Multivariable Poisson regression analysis was performed to show risk factors by incidence rate ratio (IRR) and a clinical strategy was proposed. Results Among the 579 patients who underwent interventional therapy for intracranial aneurysms, the crude incidence rate of CIE was 2.4% (95% CI, 1.2–3.6%) at our center. Headache, hemiplegia, and disorientation could be initial symptoms, and cortical blindness was the most common localized deficit. Cerebral edema and sulci effacement on CT were observed, and re-revaluation after treatments on CT/MRI showed absent lesions. The risk factors were history of stroke (IRR, 7.752; P  = 0.007), history of hypertension (IRR, 1.064; P  = 0.042), posterior circulation aneurysms (IRR, 9.412; P  = 0.004) and higher dosage of contrast agents (IRR, 1.018; P  = 0.007). After the strategy of accelerating excretion of contrast agents, reduction of intracranial pressure and anti-inflammation/vasospasm therapy, the prognosis was favorable with most patients fully recovered within 72 h. Conclusion History of stroke and posterior circulation aneurysms were main risk factors for CIE. A higher dosage of contrast agents might induce CIE, and the history of hypertension should be considered as well.