title: Periprocedural MRI perfusion imaging to assess and monitor the hemodynamic impact of intracranial angioplasty and stenting for symptomatic atherosclerotic stenosis.
abstract: We aimed to assess the clinical value of MRI perfusion imaging in the periprocedural management of intracranial atherosclerosis, analyzing if changes in mean transit time (MTT), cerebral blood volume (CBV) and cerebral blood flow (CBF) correlated with angiographic outcomes. Pre-procedural and post-procedural MRI perfusion was performed on six patients who underwent angioplasty and/or stenting for symptomatic intracranial atherosclerosis. MTT, CBV and CBF were analyzed and graded. In 83% of patients, perfusion imaging correlated with angiographic outcomes. Perfusion parameters improved to normal in two patients. Two showed marked improvement and one showed mild improvement. In one patient, the results of the post-procedural MRI perfusion prompted an angiogram, which confirmed stent occlusion. Semi-quantitative scores of MTT and CBF changed over time (p=0.05, p=0.03) whereas CBV did not change significantly (p>0.05). We conclude that MRI perfusion appears a promising technique for analyzing the impact of intracranial stenosis on cerebral hemodynamics before and after treatment.
authors.affiliation: Department of Neurosurgery, Feinberg School of Medicine, Northwestern University, 676 North St Clair Street, Suite 2210, Chicago, Illinois 60611, USA. bbendok@nmff.org
authors.forename: Bernard R
authors.initials: BR
authors.lastname: Bendok
authors.forename: Arun K
authors.initials: AK
authors.lastname: Sherma
authors.forename: Ziad A
authors.initials: ZA
authors.lastname: Hage
authors.forename: Sunit
authors.initials: S
authors.lastname: Das
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Naidech
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Surdell
authors.forename: Joseph G
authors.initials: JG
authors.lastname: Adel
authors.forename: Ali
authors.initials: A
authors.lastname: Shaibani
authors.forename: H Hunt
authors.initials: HH
authors.lastname: Batjer
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Carroll
authors.forename: Mathew
authors.initials: M
authors.lastname: Walker
mesh_terms: D000368:Aged; D017130:Angioplasty / Q000009:adverse effects / Q000379:methods; D002536:Cerebral Arteries / Q000473:pathology* / Q000503:physiopathology; D002560:Cerebrovascular Circulation / Q000502:physiology*; D005260:Female; D006439:Hemodynamics; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000473:pathology* / Q000503:physiopathology / Q000628:therapy; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D016343:Monitoring, Intraoperative / Q000379:methods*; D017063:Outcome Assessment, Health Care / Q000379:methods*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D015607:Stents; D016896:Treatment Outcome