Contrast-Induced Encephalopathy and the Blood-Brain Barrier

Area of Science:

• Neuroscience
• Vascular Medicine
• Radiology

Background:

• Contrast-induced encephalopathy (CIE) is a recognized adverse event in endovascular procedures.
• Pathological blood-brain barrier dysfunction (BBBd) is a key mechanism implicated in CIE.
• Existing research in animal and human models supports the role of BBBd in CIE.

Purpose of the Study:

• To describe an institutional case series of CIE.
• To review existing literature on the mechanistic role of BBBd in CIE.
• To identify shared risk factors for CIE and BBBd.

Main Methods:

• Comprehensive literature search of major medical databases (MEDLINE, Web of Science, Embase, CINAHL, Cochrane) up to January 31, 2022.
• Analysis of an institutional neurovascular database for CIE cases following endovascular treatment over a 6-month period.
• Informed consent was obtained from all participating patients.

Main Results:

• Literature review identified risk factors for BBBd and CIE: microvascular disease, neuroinflammation, procedural hypertension, contrast load, and altered cerebral blood flow.
• In the institutional series, 11.5% (6 of 52) of patients undergoing neuroendovascular procedures developed CIE.
• CIE cases involved treatment for ischemic stroke (4 patients) and cerebral aneurysms (2 patients), utilizing mechanical stenting or thrombectomy.

Conclusions:

• Shared risk factors for CIE and BBBd include microvascular disease, prolonged procedures, high contrast volumes, severe intraoperative hypertension, and iatrogenic endothelial injury from mechanical devices.
• These findings underscore the importance of managing these risk factors to mitigate CIE incidence.
• The study integrates clinical observations with existing research to provide a comprehensive view of CIE pathogenesis.