Wall enhancement, edema, and hydrocephalus after endovascular coil occlusion of intradural cerebral aneurysms.
OBJECTIVE
Symptomatic local inflammation, aseptic meningitis, and hydrocephalus are reported in a group of patients treated with second generation/modified platinum coils. The purpose of this study was to define the frequency and determinants of magnetic resonance (MR) imaging findings of aneurysm wall enhancement, perianeurysmal edema, and hydrocephalus in a cohort of coil-embolized intradural cerebral aneurysms treated with bare platinum or modified platinum coils (Matrix or HydroCoils).


METHODS
The authors retrospectively reviewed 359 Gd-enhanced MR follow-up studies of 181 treated aneurysms (125 ruptured) for mural enhancement. Univariate and multivariate logistic regression analyses were used to define mural enhancement associations with demographic, clinical, angiographic, treatment, and follow-up data. Embolization-related edema and hydrocephalus were defined in 95 MR imaging studies of 56 unruptured aneurysms.


RESULTS
Asymptomatic wall enhancement was observed in lesions treated with all coil types, occurring in 21 (18.6%) of 113 bare platinum coil-treated aneurysms. Independent associations were HydroCoil treatment (odds ratio [OR] 9.75, 95% confidence interval [CI] 3.45-30.75) and increasing aneurysm size (OR 3.58, 95% CI 1.99-6.95). Five (8.9%) unruptured aneurysms had asymptomatic de novo edema, and 3 (5.3%) demonstrated hydrocephalus; all had been treated with HydroCoils. Hydrocephalus presentation was delayed (8-31 months) and symptomatic in 2 patients.


CONCLUSIONS
Asymptomatic aneurysm wall enhancement occurred in 18.6% of embolizations performed with bare platinum coils, and probably represents a normal healing response. Perimural edema and hydrocephalus were observed only in patients treated with HydroCoils, but have been reported in patients treated with other modified platinum coils. These symptoms appear to represent an exaggerated inflammatory response during aneurysm healing. Increased vigilance for delayed hydrocephalus is required. Judicious clinical use of modified platinum coils is warranted until results of randomized trials are published.
Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, Toronto, ON, Canada.
Noel F
NF
Fanning
Robert A
RA
Willinsky
Karel G
KG
ter Brugge
D000328:Adult; D000368:Aged; D017130:Angioplasty / Q000009:adverse effects*; D001672:Biocompatible Materials; D001929:Brain Edema / Q000453:epidemiology* / Q000473:pathology; D015331:Cohort Studies; D004621:Embolization, Therapeutic / Q000009:adverse effects* / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000453:epidemiology* / Q000473:pathology; D002532:Intracranial Aneurysm / Q000473:pathology / Q000628:therapy*; D019344:Lactic Acid; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010984:Platinum; D011100:Polyglycolic Acid; D000077182:Polylactic Acid-Polyglycolic Acid Copolymer; D012189:Retrospective Studies
D001672:Biocompatible Materials; D000077182:Polylactic Acid-Polyglycolic Acid Copolymer; D011100:Polyglycolic Acid; D019344:Lactic Acid; D010984:Platinum