Forestier Géraud, Escalard Simon, Sedat Jacques, Saleme Suzana, Mounayer Charbel, Montcuquet Alexis, Smajda Stanislas, Cantier Marie, Gregoire Charles, Hankiewicz Karolina, Chau Yves, Suissa Laurent, Berge Jérôme, Clarençon Frédéric, Rouchaud Aymeric, Shotar Eimad
Neuroradiology Department, University Hospital of Limoges, CHU LIMOGES, 2 avenue Martin Luther-King, 87000, Limoges, France.
Interventional Neuroradiology Department, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France.
Neuroradiology. 2022 May;64(5):1037-1042. doi: 10.1007/s00234-022-02919-8. Epub 2022 Feb 24.
To report the occurrence of non-ischemic cerebral enhancing (NICE) lesions following mechanical thrombectomy (MT) through the retrospective French nationwide registry of NICE lesions. All thrombectomy capable stroke centers (TSC) in France were invited to fill out a questionnaire disseminated through a trainee-led research network (JENI-RC: Jeunes en Neuroradiologie Interventionnelle-Research Collaborative). NICE lesions were defined according to previous literature as delayed onset punctate, nodular, or annular foci enhancements with peri-lesion edema and vascular distribution in the territory of the MT with no other confounding disease. All 43 TSC French centers responded. Three patients were reported by 3 different centers over a total of 34,824 MT (2015-2020). Patient no. 1 developed symptomatic NICE lesions 8 weeks after MT with combination of aspiration and stentriever for a right middle cerebral artery occlusion. Patient no. 2 developed asymptomatic NICE lesions 5 weeks after MT with direct thromboaspiration for a right middle cerebral artery occlusion. Patient no. 3 developed symptomatic NICE lesions 6 weeks after MT with direct thromboaspiration, and combination of aspiration and stentriever for a basilar artery occlusion. This study provides evidence that NICE lesions following MT are a possible rare complication with a similar presentation as previously described following endovascular aneurysm treatment. Both radiologists and neurologists should be aware of this adverse event and make use of MRI contrast agents in case of unexplained symptoms/images during follow-up after MT.
通过法国全国性的非缺血性脑强化（NICE）病变回顾性登记研究，报告机械取栓（MT）后出现的NICE病变情况。法国所有具备取栓能力的卒中中心（TSC）均受邀填写一份通过由实习医生主导的研究网络（JENI-RC：介入神经放射学青年研究协作组）分发的调查问卷。根据既往文献，NICE病变被定义为延迟出现的点状、结节状或环状病灶强化，伴有病灶周围水肿，且位于MT区域内的血管分布区，无其他混杂疾病。法国所有43个TSC中心均做出了回应。在总共34,824例MT手术（2015 - 2020年）中，3个不同中心报告了3例患者。1号患者在MT术后8周出现有症状的NICE病变，该患者因右侧大脑中动脉闭塞接受了抽吸联合支架取栓治疗。2号患者在MT术后5周出现无症状的NICE病变，该患者因右侧大脑中动脉闭塞接受了直接血栓抽吸治疗。3号患者在MT术后6周出现有症状的NICE病变，该患者因基底动脉闭塞接受了直接血栓抽吸以及抽吸联合支架取栓治疗。本研究提供了证据，表明MT术后的NICE病变是一种可能罕见的并发症，其表现与先前描述的血管内动脉瘤治疗后的情况相似。放射科医生和神经科医生都应意识到这一不良事件，并在MT术后随访期间出现无法解释的症状/影像时使用MRI造影剂。
