Periprocedural MRI perfusion imaging to assess and monitor the hemodynamic impact of intracranial angioplasty and stenting for symptomatic atherosclerotic stenosis.
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.
Bendok
Bernard R
BR
Department of Neurosurgery, Feinberg School of Medicine, Northwestern University, 676 North St Clair Street, Suite 2210, Chicago, Illinois 60611, USA. bbendok@nmff.org
Sherma
Arun K
AK
Hage
Ziad A
ZA
Das
Sunit
S
Naidech
Andrew M
AM
Surdell
Daniel L
DL
Adel
Joseph G
JG
Shaibani
Ali
A
Batjer
H Hunt
HH
Carroll
Timothy J
TJ
Walker
Mathew
M
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