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New devices and techniques
Original research
Non-ischemic cerebral enhancing (NICE) lesions after flow diversion for intracranial aneurysms: a multicenter study
  1. Cindy Richter1,
  2. Markus A Möhlenbruch2,
  3. Dominik F Vollherbst2,
  4. Christian A Taschner3,
  5. Samer Elsheikh3,
  6. Joachim Klisch4,
  7. Donald Lobsien4,
  8. Maxim Bester5,
  9. Nora Ramdani5,
  10. Daniel P O Kaiser6,
  11. Johannes C Gerber6,
  12. Stefan Schob7,
  13. Angelos Gazis8,
  14. Paulina Smirnov1,
  15. Cordula Scherlach1,
  16. Karl-Titus Hoffmann1,
  17. Matthias Gawlitza1
  1. 1 Institute of Neuroradiology, Leipzig University Hospital, Leipzig, Germany
  2. 2 Department of Interventional Neuroradiology, University of Heidelberg, Heidelberg, Germany
  3. 3 Department of Neuroradiology, University of Freiburg Faculty of Medicine, Freiburg, Germany
  4. 4 Institute of Diagnostic and Interventional Radiology and Neuroradiology, HELIOS Hospital Erfurt, Erfurt, Germany
  5. 5 Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
  6. 6 Institute of Neuroradiology, University Hospital Carl Gustav Carus, Dresden, Germany
  7. 7 Department of Radiology and Neuroradiology, University Hospital Halle, Halle, Germany
  8. 8 Department of Radiology and Neuroradiology, St Georg Hospital, Leipzig, Germany
  1. Correspondence to Dr Cindy Richter; cindy.richter{at}medizin.uni-leipzig.de

Abstract

Background Non-ischemic cerebral enhancing (NICE) lesions have been reported as a rare complication of various neuroendovascular procedures, but information on their incidence after flow diversion is scant. It is unclear if specific devices or novel coating technologies may impact their occurrence.

Methods We conducted a multicenter study on the incidence of NICE lesions after flow diverter (FD) implantation for cerebral aneurysm treatment.

Results Eight centers identified 15 patients and provided detailed data. The clinical presentation ranged from asymptomatic to hemiplegia and cognitive impairment. The mean time to diagnosis after treatment was 65.1±101.5 days. Five centers disclosed information on all of their 1201 FD procedures during the inclusion period (2015–2022), during which 12 patients were diagnosed with NICE lesions in these institutions—that is, an incidence of 1%. FD coatings did not increase the incidence (6/591 patients (1%) treated with surface-modified FD vs 6/610 patients (1%) treated with bare FD; P=1.00). Significantly increased rates of 3.7% (6 cases in 161 procedures; P<0.01) and 3.3% (5 cases in 153 procedures; P<0.01) were found with stents of two specific product lines. The use of one product line was associated with a significantly lower incidence (0 cases in 499 procedures (0%); P<0.01).

Conclusions Novel stent coatings are not associated with an increased incidence of NICE lesions. The incidence rate of 1% suggests that these lesions may occur more often after flow diversion than after other endovascular treatments. We found a concerning accumulation of NICE lesion cases when FDs from two product families were used.

  • Aneurysm
  • Catheter
  • Complication
  • Flow Diverter
  • Inflammatory Response

Data availability statement

All data relevant to the study are included in the article.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/jnis-2023-021176

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    Data availability statement

    All data relevant to the study are included in the article.

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    Footnotes

    • X @daniel_kaiserMD

    • Contributors All authors were involved and made substantial contributions to the conception or design of the work, or the acquisition, analysis, or interpretation of the data; drafting the work or revising it critically for important intellectual content; final approval of the version published; and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. CR and MG are responsible for the overall content. CR is acting as the guarantor.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests MG: Consultancy agreements with MicroVention, Balt, phenox. Scientific advisory board of Simq. Part of the clinical event committee in a study on a flow diverter sponsored by MicroVention.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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