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

  • Interventional Neuroradiology
  • Published:
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Abstract

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.

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Authors and Affiliations

  1. Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China

    Mengxing Li, Jian Liu & Xinjian Yang

  2. Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, China

    Feng Chen

  3. Department of Neurology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China

    Chengzhe Fan

  4. Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, No. 119, South 4th Ring West Road, Fengtai District, Beijing, China

    Xuan Sun

Authors
  1. Mengxing Li
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  2. Jian Liu
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  3. Feng Chen
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  4. Chengzhe Fan
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Corresponding author

Correspondence to Xuan Sun.

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Ethical approval

The study protocol was approved by the ethics committee of Beijing Tiantan Hospital, and the approval number given by the ethical board was KY 2018–098-02.

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Participants gave informed consent to participate in the study before taking part.

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We declare that we have no conflict of interest.

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Li, M., Liu, J., Chen, F. et al. Contrast-induced encephalopathy following endovascular treatment for intracranial aneurysms—risk factors analysis and clinical strategy. Neuroradiology 65, 629–635 (2023). https://doi.org/10.1007/s00234-022-03077-7

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  • DOI: https://doi.org/10.1007/s00234-022-03077-7

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