Contrast Enhancement Hyperdensity After Endovascular Coiling of Intracranial Aneurysms

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Fig 1.
A, immediate postembolization noncontrast head CT shows a gyral pattern of enhancement (arrows). B, C, interval resolution of enhancement at 6 hours (B) and 24 hours (C), respectively (arrows).
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Fig 2.
A, B, immediate postembolization noncontrast head CT shows left caudate (A) and gyral (B) enhancement (arrows). C, D, interval improvement of caudate (C) and gyral (D) enhancement at 6 hours (arrows). E, F, resolution of caudate (E) and gyral (F) enhancement at 24 hours.
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Fig 3.
A, immediate postembolization noncontrast head CT shows a gyral pattern of enhancement (arrow). B, noncontrast head CT obtained at presentation without gyral subarachnoid blood in the area of postcoiling enhancement. C,D, interval resolution of enhancement at 6 hours (C) and 24 hours (D), respectively (arrows).

Table 1:

Patient data of cases with postprocedural CT hyperdensities

Sex/Age	Treated Aneurysm	Stent Assist	Perioperative Antiplatelets	Location of Enhancement	HU Postprocedure	HU 4–6 Hours	HU 20–25 Hours	Clinical Change
F/42	Unruptured 6 mm left superior hypophyseal	No	Aspirin^*	Caudate	48	41	N/A	None
M/43	Unruptured 6 mm AcomA	No	Aspirin^† clopidogrel^†	Caudate/Gyral	46/60	43/41	resolved	None
M/62	Unruptured 8 mm AcomA	No	Aspirin^† abciximab^§	Caudate/Gyral	50/67	40/45	resolved	None
F/65	Unruptured 5 mm left MCA	No	Aspirin^† clopidogrel^† abciximab^‡	Gyral	59	47	resolved	None
F/80	SAH, 5 mm basilar tip	Yes	Aspirin^† clopidogrel^† abciximab^‡^§	Gyral	53	52	39	None
F/61	Unruptured 22 mm left supraclinoid ICA	Yes	Aspirin^* clopidogrel^*	Gyral	47	44	resolved	None
F/68	Unruptured 7 mm AcomA	No	Aspirin^†	Gyral	46	42	resolved	None

Note:—F indicates female; M, male; SAH, subarachnoid hemorrhage; N/A, not available; AcomA, anterior communicating artery; MCA, middle cerebral artery; ICA, internal carotid artery; HU, Hounsfield units.
* Premedication ≥5 days.
† Started day of procedure.
‡ Intra-arterial intraoperative.
§ Intravenous intraoperative and immediately postoperative.

Table 2:

Procedure data on treated patients

Patient No.	CEH	Contrast (mL/kg)	Contrast (mgI/kg)	Procedure Time (min)
1	−	3.33	1065.6	153
2	−	3.18	1017.6	164
3	−	1.70	544.0	160
4	+	7.47	2390.4	102
5	−	5.13	1641.6	237
6	−	2.51	803.2	252
7	−	2.44	780.8	125
8	+	6.77	2166.4	180
9	−	4.07	1302.4	66
10	−	0.86	275.2	116
11	−	N/A	N/A	199
12	−	4.40	1408.0	97
13	−	3.59	1148.8	160
14	−	4.16	1331.2	139
15	−	4.72	1510.4	356
16	+	6.24	1996.8	243
17	−	N/A	N/A	127
18	−	7.69	2460.8	41
19	−	4.10	1312.0	225
20	+	5.29	1692.8	188
21	−	6.54	2092.8	300
22	−	N/A	N/A	260
23	−	1.51	483.2	130
24	−	4.26	1363.2	150
25	−	5.30	1696.0	232
26	−	2.36	755.2	190
27	+	2.56	819.2	310
28	−	0.69	220.8	49
29	+	4.08	1305.6	360
30	+	7.76	2483.2	420