Contrast-induced neurotoxicity (CIN) is an adverse reaction to contrast agents which can occur in the context of diagnostic and therapeutic neurological endovascular procedures. Our goal was to conduct a systematic review of patients reported in the literature diagnosed with CIN after neurological endovascular procedures. A systematic search of EMBASE and MEDLINE databases was conducted. Inclusion criteria were age ≥ 18 years; neurological endovascular procedure performed ≤ 24 h before ictus; new manifestations compatible with encephalic dysfunction; imaging performed < 7 days after ictus; exclusion of other causes and manifestations attributed to pre-existing conditions. Forty-eight patients were included, of which 60.4% were female and 60.4% had arterial hypertension; median age was 63 years. The most frequent procedure was diagnostic cerebral angiography (n = 24, 50.0%) and non-ionic contrast agents were more frequently used (n = 40, 83.3%). Twenty-six patients (54.2%) developed clinical manifestations compatible with CIN during or immediately after the procedure, and the most frequent manifestations were encephalopathy, cortical blindness and motor deficit. The most frequent imaging findings were cortical contrast enhancement on CT (n = 23/42), and cortical sulci effacement (n = 18/48). Most patients presented complete clinical recovery (89.6%) at a median time of 3 days. Among patients with neuroimaging changes who underwent follow-up, complete regression of the abnormalities was shown in 81.5% at a median time of 5 days. CIN is a rare adverse reaction in the context of neurological endovascular procedures. Recognition of clinical manifestations and typical imaging abnormalities, while excluding other causes, is essential for diagnosis.
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http://dx.doi.org/10.1007/s13760-020-01508-x | DOI Listing |
Ann Ital Chir
January 2025
Institute of Central Nervous System Vascular Injury and Repair, Jining Medical Science Research Institute, The First People's Hospital of Jining, 272000 Jining, Shandong, China.
Aim: This study aims to report a rare case of an embolization protection device (EPD) entrapment during Carotid Artery Stent (CAS) and to discuss the management strategy, including open surgery and concurrent carotid endarterectomy (CEA).
Case Presentation: A 71-year-old female presented with left limb weakness and unclear speech following CAS. Imaging revealed a new cerebral infarction and right internal carotid artery stenosis.
Neurosurg Rev
January 2025
Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
To evaluate the incidence of mortality, hemorrhage, and neurological deficits in treating intracranial arteriovenous malformations (AVMs) in patients over 18 through a comparative analysis of surgical approaches and other therapeutic modalities. A systematic review was conducted using MEDLINE, Embase, CENTRAL, and LILACS databases in November 2023. Inclusion criteria included clinical trials, cohorts studies, case-controls studies, and case series comparing patients over 18 undergoing surgery or microsurgery versus other treatments (radiosurgery, isolated embolization, and conservative treatment).
View Article and Find Full Text PDFNeuroradiology
January 2025
Neuroendovascular Program, Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Introduction: Mechanical thrombectomy (MT) efficacy in medium vessel occlusion (MeVO) stroke, particularly in patients with low Alberta Stroke Program Early Computed Tomography Score (ASPECTS), remains less explored.
Methods: This retrospective study analyzed data from 443 AIS patients treated with MT for MeVO and low ASPECTS (4-7) at 37 centers across North America, Asia, and Europe, from September 2017 to July 2021. Patients were categorized into ASPECTS of 4-5 and 6-7.
BMJ
January 2025
Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China.
Objective: To assess whether intra-arterial tenecteplase administered after successful endovascular recanalisation improves outcomes in patients with acute arterial occlusion of the posterior circulation.
Design: Multicentre randomised controlled trial.
Setting: 31 hospitals in China, 24 January 2023 to 24 August 2023.
Neurosurg Rev
January 2025
Kobayashi Hospital, 510 Imaichi, Izumo City, Shimane, 693-0001, Japan.
Adverse effects of advanced age and poor initial neurological status on outcomes of patients with aneurysmal subarachnoid hemorrhage (SAH) have been documented. While a predictive model of the non-linear correlation between advanced age and clinical outcome has been reported, no previous model has been validated. Therefore, we created a prediction model of the non-linear correlation between advanced age and clinical outcome by machine learning and validated it using a separate cohort.
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