Non-ischemic cerebral enhancing (NICE) lesions after extracranial carotid stenting: A case report
Abstract
Non-ischemic cerebral enhancing (NICE) lesions are exceptionally rare complications of neuroendovascular procedures and have been reported predominantly after intracranial interventions, with only one previous case following extracranial carotid stenting. We report a second such case. A woman in her mid-thirties with inactive Takayasu arteritis underwent long-segment extracranial stenting of asymptomatic stenoses of the left common (CCA) and internal carotid (ICA) arteries using three overlapping stents. Eighteen days after the procedure, she developed new-onset headache; MRI showed a small left parieto-occipital hemorrhage and multiple ipsilateral NICE lesions. Serial MRI over 10 months demonstrated asynchronous NICE lesion behavior, with simultaneous emergence, regression, and persistence of ipsilateral and contralateral foci. Their non-ischemic morphology and the absence of clinical, laboratory, CSF, or vascular imaging evidence of active vasculitis argued against a Takayasu-related origin. Despite fluctuating lesion burden, she developed no persistent neurological deficits and required no long-term immunosuppressive therapy. Mild headaches and a one-day cluster of focal sensory seizures occurred, with no recurrence under low-dose lamotrigine. This case provides further evidence that NICE lesions are not confined to intracranial procedures and may also follow extracranial carotid stenting, showing highly variable lesion dynamics. The continued appearance of new lesions up to 308 days after stenting suggests persistent microembolization or delayed inflammatory manifestation of initially occult embolic deposits rather than a purely one-time periprocedural event. The divergence between radiological lesion burden and clinical severity further suggests that management should be guided primarily by the clinical course and that conservative management may be appropriate in clinically stable patients.
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BibTeX
@article{itter2026nonischemic,
title = {{Non-ischemic cerebral enhancing (NICE) lesions after extracranial carotid stenting: A case report}},
author = {Jonas von Itter MD and Marc-Nicolas von Itter MD and Lucia Härtel MD and Matthias Pawlowski MD, PhD and Maik F. H. Böhmer MD and Hermann Krähling MD and Wolfram Schwindt MD and Christian Paul Stracke MD and Antje Schmidt-Pogoda MD},
journal = {Therapeutic Advances in Neurological Disorders},
year = {2026},
month = oct,
doi = {10.1177/17562864261491046},
url = {https://doi.org/10.1177/17562864261491046},
note = {CC BY},
}
RIS
TY - JOUR
TI - Non-ischemic cerebral enhancing (NICE) lesions after extracranial carotid stenting: A case report
AU - Jonas von Itter MD
AU - Marc-Nicolas von Itter MD
AU - Lucia Härtel MD
AU - Matthias Pawlowski MD, PhD
AU - Maik F. H. Böhmer MD
AU - Hermann Krähling MD
AU - Wolfram Schwindt MD
AU - Christian Paul Stracke MD
AU - Antje Schmidt-Pogoda MD
PY - 2026
DA - 2026/10/23
JO - Therapeutic Advances in Neurological Disorders
DO - 10.1177/17562864261491046
UR - https://doi.org/10.1177/17562864261491046
AB - Non-ischemic cerebral enhancing (NICE) lesions are exceptionally rare complications of neuroendovascular procedures and have been reported predominantly after intracranial interventions, with only one previous case following extracranial carotid stenting. We report a second such case. A woman in her mid-thirties with inactive Takayasu arteritis underwent long-segment extracranial stenting of asymptomatic stenoses of the left common (CCA) and internal carotid (ICA) arteries using three overlapping stents. Eighteen days after the procedure, she developed new-onset headache; MRI showed a small left parieto-occipital hemorrhage and multiple ipsilateral NICE lesions. Serial MRI over 10 months demonstrated asynchronous NICE lesion behavior, with simultaneous emergence, regression, and persistence of ipsilateral and contralateral foci. Their non-ischemic morphology and the absence of clinical, laboratory, CSF, or vascular imaging evidence of active vasculitis argued against a Takayasu-related origin. Despite fluctuating lesion burden, she developed no persistent neurological deficits and required no long-term immunosuppressive therapy. Mild headaches and a one-day cluster of focal sensory seizures occurred, with no recurrence under low-dose lamotrigine. This case provides further evidence that NICE lesions are not confined to intracranial procedures and may also follow extracranial carotid stenting, showing highly variable lesion dynamics. The continued appearance of new lesions up to 308 days after stenting suggests persistent microembolization or delayed inflammatory manifestation of initially occult embolic deposits rather than a purely one-time periprocedural event. The divergence between radiological lesion burden and clinical severity further suggests that management should be guided primarily by the clinical course and that conservative management may be appropriate in clinically stable patients.
SN - 1756-2864
SN - 1756-2856
ER -