LAUSR

BACKGROUND Contrast-induced neurotoxicity (CIN) is an infrequent complication of endovascular procedures, and its understanding remains scarce. We aimed to study and characterize the clinical and imaging features of a case series of CIN after neurointerventional surgery. METHODS We reviewed all neuroendovascular consecutive procedures from September 2014 to November 2018. CIN was defined as new onset of neurological deficits that occurred postoperatively after excluding other conditions. All demographic, clinical, procedural, and radiological data were retrospectively analyzed and collected. RESULTS 11 CIN cases of 1587 patients were identified out of 2510 procedures. The median age was 76 (IQR 65-81). The most common comorbidity was hypertension (82%). Median procedure time was 100 minutes (IQR 80-130.5). All patients demonstrated wide variability in intraprocedural blood pressure recordings with fluctuations from the baseline blood pressure (BP). SBP ranged from 83 mmHg below the patient baseline to 80 mmHg above baseline. The median symptom onset was four hours (IQR 0.8-9.5h). The CIN symptomatology presented gradually, initially with encephalopathy and later with focal signs. All the patients had an initial CT scan which demonstrated ipsilateral cerebral edema in 82% of the cases. Two of them had contrast enhancement. Complete resolution of CIN symptoms was obtained in a median time of 3 days (IQR: 2.5-3). CONCLUSION CIN should be considered in the context of the progressive onset of neurological deficits after neuroendovascular procedures. A distinct imaging pattern of ipsilateral hemisphere edema in the absence of ischemia is usually identified. Variability in procedural BP might be a predisposing factor.