Perianeurysmal Edema After Embolization with Flow Diversion

Mehrnoush Gorjian; Scott Raymond; Matthew Koch; Aman Patel

doi:doi:10.11648/j.ijn.20190301.13

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Perianeurysmal Edema After Embolization with Flow Diversion

Mehrnoush Gorjian, Scott Raymond, Matthew Koch, Aman Patel

Published in International Journal of Neurosurgery (Volume 3, Issue 1)

Received: 23 June 2019 Accepted: 4 August 2019 Published: 19 August 2019

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Abstract

Flow diversion is an endovascular technique for embolization of intracranial aneurysms using a semi-porous stent to that redirects blood flow away from the aneurysm and is a scaffold for vessel remodeling. With flow diversion, aneurysms close slowly over 6-12 months as endothelial growth into the stent covers the neck of the aneurysm. Flow diversion is the preferred treatment for unruptured, large, paraclinoid aneurysms, which are otherwise challenging to treat with conventional open surgical or endovascular techniques. Post-embolization perianeurysmal edema (PAE) is an uncommon complication that occurs weeks to months after embolization and manifests as brain parenchymal edema surrounding the treated aneurysm. The clinical presentation is varied and includes headache, seizure or focal neurologic deficit. Frequently, PAE is misdiagnosed as an embolic stroke, which is a more common post-embolization complication and has some clinical and imaging overlap. PAE can be differentiated from ischemia by the absence of restricted diffusion and aneurysm wall enhancement on post-contrast Magnetic Resonance Imaging (MRI). PAE was initially described following coil embolization, but has subsequently been observed after flow diversion alone or with adjunctive coiling. Post-embolization PAE presumably results from rapid aneurysm thrombosis, endothelial cell necrosis, and the ensuing inflammatory reaction, which spreads to the adjacent brain parenchyma. Early recognition of PAE is critical to initiate appropriate therapy.

Published in	International Journal of Neurosurgery (Volume 3, Issue 1)
DOI	10.11648/j.ijn.20190301.13
Page(s)	9-12
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Perianeurysmal Edema, Flow Diversion Stent, Coil Embolization, Intracranial Aneurysm

References

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[2]	Chalouhi N, Daou B, Barros G, Starke RM, Chitale A, Ghobrial G, Dalyai R, Hasan D, Gonzalez LF, Tjoumakaris S, Rosenwasser RH, Jabbour P. Matched Comparison of Flow Diversion and Coiling in Small, Noncomplex Intracranial Aneurysms. Neurosurgery. 2017 Jul 1; 81 (1): 92-97. doi: 10.1093/neuros/nyw070.
[3]	Chalouhi N, Tjoumakaris S, Starke RM, Gonzalez LF, Randazzo C, Hasan D, McMahon JF, Singhal S, Moukarzel LA, Dumont AS, Rosenwasser R, Jabbour P. Comparison of flow diversion and coiling in large unruptured intracranial saccular aneurysms. Stroke. 2013 Aug; 44 (8): 2150-4. doi: 10.1161/STROKEAHA.113.001785. Epub 2013 May 30.
[4]	Burrows AM, Cloft H, Kallmes DF, Lanzino G. Periprocedural and mid-term technical and clinical events after flow diversion for intracranial aneurysms. J Neurointerv Surg. 2015 Sep; 7 (9): 646-51. doi: 10.1136/neurintsurg-2014-011184. Epub 2014 Jul 31.
[5]	Shapiro, M., Ollenschleger, M. D., Baccin, C. E., Becske, T., Spiegel, G. R., Wang, Y., Song, X., Raz, E., Zumofen, D. W., Potts, M., Nelson, P. K. "Foreign Body Emboli following Cerebrovascular Interventions: Clinical, Radiographic, and Histopathologic Features." American journal of neuroradiology 36.11 (2015): 2121-6.
[6]	Craven I, Patel UJ, Gibson A, Coley SC. Symptomatic Perianeurysmal Edema Following Bare Platinum Embolization of a Small Unruptured Cerebral Aneurysm. Am J Neuroradiol. 2009; 30 (10): 1998-2000. doi: 10.3174/ajnr.A1643.
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[10]	Cohen JE, Itshayek E, Attia M, Moscovici S. Postembolization perianeurysmal edema as a cause of uncinate seizures. J Clin Neurosci. 2012. doi: 10.1016/j.jocn.2011.08.008.
[11]	Al-Mufti F, Amuluru K, Gandhi CD, Prestigiacomo CJ. Flow Diversion for Intracranial Aneurysm Management: A New Standard of Care. Neurotherapeutics. 2016. doi: 10.1007/s13311-016-0436-4.
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APA Style

Mehrnoush Gorjian, Scott Raymond, Matthew Koch, Aman Patel. (2019). Perianeurysmal Edema After Embolization with Flow Diversion. International Journal of Neurosurgery, 3(1), 9-12. https://doi.org/10.11648/j.ijn.20190301.13

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ACS Style

Mehrnoush Gorjian; Scott Raymond; Matthew Koch; Aman Patel. Perianeurysmal Edema After Embolization with Flow Diversion. Int. J. Neurosurg. 2019, 3(1), 9-12. doi: 10.11648/j.ijn.20190301.13

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AMA Style

Mehrnoush Gorjian, Scott Raymond, Matthew Koch, Aman Patel. Perianeurysmal Edema After Embolization with Flow Diversion. Int J Neurosurg. 2019;3(1):9-12. doi: 10.11648/j.ijn.20190301.13

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@article{10.11648/j.ijn.20190301.13,
  author = {Mehrnoush Gorjian and Scott Raymond and Matthew Koch and Aman Patel},
  title = {Perianeurysmal Edema After Embolization with Flow Diversion},
  journal = {International Journal of Neurosurgery},
  volume = {3},
  number = {1},
  pages = {9-12},
  doi = {10.11648/j.ijn.20190301.13},
  url = {https://doi.org/10.11648/j.ijn.20190301.13},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijn.20190301.13},
  abstract = {Flow diversion is an endovascular technique for embolization of intracranial aneurysms using a semi-porous stent to that redirects blood flow away from the aneurysm and is a scaffold for vessel remodeling. With flow diversion, aneurysms close slowly over 6-12 months as endothelial growth into the stent covers the neck of the aneurysm. Flow diversion is the preferred treatment for unruptured, large, paraclinoid aneurysms, which are otherwise challenging to treat with conventional open surgical or endovascular techniques. Post-embolization perianeurysmal edema (PAE) is an uncommon complication that occurs weeks to months after embolization and manifests as brain parenchymal edema surrounding the treated aneurysm. The clinical presentation is varied and includes headache, seizure or focal neurologic deficit. Frequently, PAE is misdiagnosed as an embolic stroke, which is a more common post-embolization complication and has some clinical and imaging overlap. PAE can be differentiated from ischemia by the absence of restricted diffusion and aneurysm wall enhancement on post-contrast Magnetic Resonance Imaging (MRI). PAE was initially described following coil embolization, but has subsequently been observed after flow diversion alone or with adjunctive coiling. Post-embolization PAE presumably results from rapid aneurysm thrombosis, endothelial cell necrosis, and the ensuing inflammatory reaction, which spreads to the adjacent brain parenchyma. Early recognition of PAE is critical to initiate appropriate therapy.},
 year = {2019}
}

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TY  - JOUR
T1  - Perianeurysmal Edema After Embolization with Flow Diversion
AU  - Mehrnoush Gorjian
AU  - Scott Raymond
AU  - Matthew Koch
AU  - Aman Patel
Y1  - 2019/08/19
PY  - 2019
N1  - https://doi.org/10.11648/j.ijn.20190301.13
DO  - 10.11648/j.ijn.20190301.13
T2  - International Journal of Neurosurgery
JF  - International Journal of Neurosurgery
JO  - International Journal of Neurosurgery
SP  - 9
EP  - 12
PB  - Science Publishing Group
SN  - 2640-1959
UR  - https://doi.org/10.11648/j.ijn.20190301.13
AB  - Flow diversion is an endovascular technique for embolization of intracranial aneurysms using a semi-porous stent to that redirects blood flow away from the aneurysm and is a scaffold for vessel remodeling. With flow diversion, aneurysms close slowly over 6-12 months as endothelial growth into the stent covers the neck of the aneurysm. Flow diversion is the preferred treatment for unruptured, large, paraclinoid aneurysms, which are otherwise challenging to treat with conventional open surgical or endovascular techniques. Post-embolization perianeurysmal edema (PAE) is an uncommon complication that occurs weeks to months after embolization and manifests as brain parenchymal edema surrounding the treated aneurysm. The clinical presentation is varied and includes headache, seizure or focal neurologic deficit. Frequently, PAE is misdiagnosed as an embolic stroke, which is a more common post-embolization complication and has some clinical and imaging overlap. PAE can be differentiated from ischemia by the absence of restricted diffusion and aneurysm wall enhancement on post-contrast Magnetic Resonance Imaging (MRI). PAE was initially described following coil embolization, but has subsequently been observed after flow diversion alone or with adjunctive coiling. Post-embolization PAE presumably results from rapid aneurysm thrombosis, endothelial cell necrosis, and the ensuing inflammatory reaction, which spreads to the adjacent brain parenchyma. Early recognition of PAE is critical to initiate appropriate therapy.
VL  - 3
IS  - 1
ER  -

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Author Information

Mehrnoush Gorjian

Department of Neurosurgery, Massachusetts General Hospital, Boston, USA
Scott Raymond

Department of Neurosurgery, Massachusetts General Hospital, Boston, USA
Matthew Koch

Department of Neurosurgery, Massachusetts General Hospital, Boston, USA
Aman Patel

Department of Neurosurgery, Massachusetts General Hospital, Boston, USA

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Plain Text BibTeX RIS

APA Style

Mehrnoush Gorjian, Scott Raymond, Matthew Koch, Aman Patel. (2019). Perianeurysmal Edema After Embolization with Flow Diversion. International Journal of Neurosurgery, 3(1), 9-12. https://doi.org/10.11648/j.ijn.20190301.13

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ACS Style

Mehrnoush Gorjian; Scott Raymond; Matthew Koch; Aman Patel. Perianeurysmal Edema After Embolization with Flow Diversion. Int. J. Neurosurg. 2019, 3(1), 9-12. doi: 10.11648/j.ijn.20190301.13

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AMA Style

Mehrnoush Gorjian, Scott Raymond, Matthew Koch, Aman Patel. Perianeurysmal Edema After Embolization with Flow Diversion. Int J Neurosurg. 2019;3(1):9-12. doi: 10.11648/j.ijn.20190301.13

Copy | Download

@article{10.11648/j.ijn.20190301.13,
  author = {Mehrnoush Gorjian and Scott Raymond and Matthew Koch and Aman Patel},
  title = {Perianeurysmal Edema After Embolization with Flow Diversion},
  journal = {International Journal of Neurosurgery},
  volume = {3},
  number = {1},
  pages = {9-12},
  doi = {10.11648/j.ijn.20190301.13},
  url = {https://doi.org/10.11648/j.ijn.20190301.13},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijn.20190301.13},
  abstract = {Flow diversion is an endovascular technique for embolization of intracranial aneurysms using a semi-porous stent to that redirects blood flow away from the aneurysm and is a scaffold for vessel remodeling. With flow diversion, aneurysms close slowly over 6-12 months as endothelial growth into the stent covers the neck of the aneurysm. Flow diversion is the preferred treatment for unruptured, large, paraclinoid aneurysms, which are otherwise challenging to treat with conventional open surgical or endovascular techniques. Post-embolization perianeurysmal edema (PAE) is an uncommon complication that occurs weeks to months after embolization and manifests as brain parenchymal edema surrounding the treated aneurysm. The clinical presentation is varied and includes headache, seizure or focal neurologic deficit. Frequently, PAE is misdiagnosed as an embolic stroke, which is a more common post-embolization complication and has some clinical and imaging overlap. PAE can be differentiated from ischemia by the absence of restricted diffusion and aneurysm wall enhancement on post-contrast Magnetic Resonance Imaging (MRI). PAE was initially described following coil embolization, but has subsequently been observed after flow diversion alone or with adjunctive coiling. Post-embolization PAE presumably results from rapid aneurysm thrombosis, endothelial cell necrosis, and the ensuing inflammatory reaction, which spreads to the adjacent brain parenchyma. Early recognition of PAE is critical to initiate appropriate therapy.},
 year = {2019}
}

Copy | Download

TY  - JOUR
T1  - Perianeurysmal Edema After Embolization with Flow Diversion
AU  - Mehrnoush Gorjian
AU  - Scott Raymond
AU  - Matthew Koch
AU  - Aman Patel
Y1  - 2019/08/19
PY  - 2019
N1  - https://doi.org/10.11648/j.ijn.20190301.13
DO  - 10.11648/j.ijn.20190301.13
T2  - International Journal of Neurosurgery
JF  - International Journal of Neurosurgery
JO  - International Journal of Neurosurgery
SP  - 9
EP  - 12
PB  - Science Publishing Group
SN  - 2640-1959
UR  - https://doi.org/10.11648/j.ijn.20190301.13
AB  - Flow diversion is an endovascular technique for embolization of intracranial aneurysms using a semi-porous stent to that redirects blood flow away from the aneurysm and is a scaffold for vessel remodeling. With flow diversion, aneurysms close slowly over 6-12 months as endothelial growth into the stent covers the neck of the aneurysm. Flow diversion is the preferred treatment for unruptured, large, paraclinoid aneurysms, which are otherwise challenging to treat with conventional open surgical or endovascular techniques. Post-embolization perianeurysmal edema (PAE) is an uncommon complication that occurs weeks to months after embolization and manifests as brain parenchymal edema surrounding the treated aneurysm. The clinical presentation is varied and includes headache, seizure or focal neurologic deficit. Frequently, PAE is misdiagnosed as an embolic stroke, which is a more common post-embolization complication and has some clinical and imaging overlap. PAE can be differentiated from ischemia by the absence of restricted diffusion and aneurysm wall enhancement on post-contrast Magnetic Resonance Imaging (MRI). PAE was initially described following coil embolization, but has subsequently been observed after flow diversion alone or with adjunctive coiling. Post-embolization PAE presumably results from rapid aneurysm thrombosis, endothelial cell necrosis, and the ensuing inflammatory reaction, which spreads to the adjacent brain parenchyma. Early recognition of PAE is critical to initiate appropriate therapy.
VL  - 3
IS  - 1
ER  -

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