Ischemic lesions in perforating arteries after flow diversion of middle cerebral aneurysms: a single-center cohort with MRI-monitored complications
Abstract
BACKGROUND AND PURPOSE: Ischemic events are a recognized complication of flow diversion stents (FDS) in middle cerebral artery (MCA) aneurysms, often related to branch or perforator coverage. However, the clinical significance of isolated lenticulostriate artery territory infarcts following FDS remains incompletely understood. METHOD: We retrospectively reviewed consecutive patients treated with FDS for MCA aneurysms between January 2013 and December 2024. Baseline demographics, vascular risk factors, aneurysm and procedural characteristics were collected. Functional outcomes were assessed by the modified Rankin Scale (mRS) at discharge and at 6 months. All patients underwent magnetic resonance imaging (MRI) within 24-48 h after treatment. RESULTS: Forty-two patients were included (69% women; mean age 55.1 years). Diffusion-weighted imaging identified ischemic lesions in 6 patients (14.2%), exclusively within the lenticulostriate artery territory; 4 were clinically silent, and 2 patients (4.8%) had an mRS ≥ 2 at discharge. Ischemic lesions were significantly associated with diabetes mellitus (χ² = 19.385, p < 0.001) and dyslipidemia (χ² = 5.933, p = 0.015). No significant associations were observed with hypertension, smoking status, antiplatelet regimen, device type, or device size. Higher stent-to-vessel diameter ratios showed a non-significant trend toward lower odds of perforator territory ischemia. CONCLUSION: In this single-center study, flow diversion for MCA aneurysms was associated with a measurable rate of lenticulostriate territory ischemia, most of which was clinically silent. The strong associations with metabolic comorbidities and the observed influence of device-vessel relationships highlight the importance of patient selection and vascular risk factor optimization. Prospective studies with standardized imaging and neurocognitive follow-up are warranted to clarify the long-term significance of asymptomatic ischemic lesions.
Related
- Hemodynamic-Structural Multi-Fidelity Assessment of Endovascular Flow Diversion Strategies for Cerebral Aneurysm Treatment: An Integrated Computational and Experimental Framework
- A case report of liver transplantation following a biliopancreatic diversion: A friendly cohabitation?
- An Indirect Organogenesis-Based Citrus Transformation System Monitored Using Visible Reporter Markers
- Clinical experience with ventriculovesical shunting as a salvage or bridging strategy in children with hydrocephalus when peritoneal diversion was considered unsuitable: a retrospective case series.
- An indirect organogenesis-based citrus transformation system monitored using visible reporter markers
BibTeX
@article{afonso2026ischemic,
title = {{Ischemic lesions in perforating arteries after flow diversion of middle cerebral aneurysms: a single-center cohort with MRI-monitored complications}},
author = {Henrique Alves Costa Afonso and Natalia Vasconcellos de Oliveira Souza and Géraud Forestier and Florent Dupraz and Bruna Venturieri and Suzana Saleme and Aymeric Rouchaud and Iruena Moraes Kessler and Charbel Mounayer},
journal = {Journal de Neuroradiologie / Journal of Neuroradiology},
year = {2026},
month = sep,
doi = {10.1016/j.neurad.2026.101546},
url = {https://hal.science/hal-05751610v1},
note = {CC BY},
}
RIS
TY - JOUR
TI - Ischemic lesions in perforating arteries after flow diversion of middle cerebral aneurysms: a single-center cohort with MRI-monitored complications
AU - Henrique Alves Costa Afonso
AU - Natalia Vasconcellos de Oliveira Souza
AU - Géraud Forestier
AU - Florent Dupraz
AU - Bruna Venturieri
AU - Suzana Saleme
AU - Aymeric Rouchaud
AU - Iruena Moraes Kessler
AU - Charbel Mounayer
PY - 2026
DA - 2026/09/16
JO - Journal de Neuroradiologie / Journal of Neuroradiology
DO - 10.1016/j.neurad.2026.101546
UR - https://hal.science/hal-05751610v1
AB - BACKGROUND AND PURPOSE: Ischemic events are a recognized complication of flow diversion stents (FDS) in middle cerebral artery (MCA) aneurysms, often related to branch or perforator coverage. However, the clinical significance of isolated lenticulostriate artery territory infarcts following FDS remains incompletely understood. METHOD: We retrospectively reviewed consecutive patients treated with FDS for MCA aneurysms between January 2013 and December 2024. Baseline demographics, vascular risk factors, aneurysm and procedural characteristics were collected. Functional outcomes were assessed by the modified Rankin Scale (mRS) at discharge and at 6 months. All patients underwent magnetic resonance imaging (MRI) within 24-48 h after treatment. RESULTS: Forty-two patients were included (69% women; mean age 55.1 years). Diffusion-weighted imaging identified ischemic lesions in 6 patients (14.2%), exclusively within the lenticulostriate artery territory; 4 were clinically silent, and 2 patients (4.8%) had an mRS ≥ 2 at discharge. Ischemic lesions were significantly associated with diabetes mellitus (χ² = 19.385, p < 0.001) and dyslipidemia (χ² = 5.933, p = 0.015). No significant associations were observed with hypertension, smoking status, antiplatelet regimen, device type, or device size. Higher stent-to-vessel diameter ratios showed a non-significant trend toward lower odds of perforator territory ischemia. CONCLUSION: In this single-center study, flow diversion for MCA aneurysms was associated with a measurable rate of lenticulostriate territory ischemia, most of which was clinically silent. The strong associations with metabolic comorbidities and the observed influence of device-vessel relationships highlight the importance of patient selection and vascular risk factor optimization. Prospective studies with standardized imaging and neurocognitive follow-up are warranted to clarify the long-term significance of asymptomatic ischemic lesions.
SN - 0150-9861
ER -