Functional MR imaging in patients with carotid artery stenosis before and after revascularization.
OBJECTIVE
Significant extracranial stenosis of the ICA is a known risk factor for future stroke and it has been shown that revascularization reduces the risk of future stroke. We applied BOLD fMRI in patients with carotid artery stenosis before and after CEA. Our purpose was to determine whether fMRI is able to demonstrate impaired CVR and to identify patient parameters that are associated with postoperative changes of cerebral hemodynamics.


METHODS
Nineteen consecutive patients with symptomatic (n = 13) and asymptomatic (n = 6) stenosis of the ICA were prospectively recruited (male/female ratio = 16:3; age, 69 ± 8,1 years). fMRI using a simple bilateral motor task was performed immediately before and after CEA.


RESULTS
Mean BOLD MSC was significantly increased postoperatively (MSC, 0.13 ± 0.66; P = 0.0002). Patients with a stenosis of <80% demonstrated an increase in MSC (MSC, 0.32 ± 0.59; P ≤ .0001). Patients with previous ischemic stroke showed a larger MSC than patients with TIAs (stroke: MSC, 0.55 ± 0.65; P ≤ .0001; TIA: MSC, 0.05 ± 0.26; P = 0.054). Patients older than 70 years had a significantly larger MSC following surgery (≤70 years: MSC, -0.01 ± 0.39; P = .429; >70 years: MSC, 0.29 ± 0.48; P ≤ .0001).


CONCLUSIONS
BOLD fMRI can demonstrate changes in cerebral hemodynamics before and after CEA, indicative of an ameliorated CVR. This response is dependent on the age of the patient, the degree of preoperative stenosis, and the patient's symptoms.
Schaaf
M
M
Departments of Neuroradiology, University Hospital Aachen, Aachen University, Germany.
Mommertz
G
G
Ludolph
A
A
Geibprasert
S
S
Mühlenbruch
G
G
Das
M
M
Krings
T
T
D017677:Age Distribution; D000368:Aged; D016893:Carotid Stenosis / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery*; D002548:Cerebral Revascularization; D002560:Cerebrovascular Circulation / Q000502:physiology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000098:blood supply; D011184:Postoperative Period; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011446:Prospective Studies; D012307:Risk Factors
Cerebrovasc Dis. 2008;26(3):231-6
18648194
JAMA. 1995 May 10;273(18):1421-8
7723155
Neurology. 2003 Nov 11;61(9):1276-9
14610138
Stroke. 2000 Apr;31(4):924-9
10754000
Proc Natl Acad Sci U S A. 1992 Jun 15;89(12):5675-9
1608978
Radiology. 1993 Feb;186(2):316-8
8421726
Cerebrovasc Dis. 2006;21(3):145-53
16401883
Stroke. 1999 May;30(5):939-45
10229724
Stroke. 1996 Nov;27(11):1970-3
8898800
J Stroke Cerebrovasc Dis. 2005 Nov-Dec;14(6):234-8
17904032
N Engl J Med. 1991 Aug 15;325(7):445-53
1852179
Ann Neurol. 2004 Dec;56(6):796-802
15562431
AJNR Am J Neuroradiol. 2002 Aug;23(7):1222-8
12169483
Ann Intern Med. 1987 Jan;106(1):27-34
3491558
Stroke. 2005 Apr;36(4):751-6
15705935
Stroke. 2002 Jan;33(1):103-9
11779897
Nat Neurosci. 2007 Nov;10(11):1377-86
17965658
Prog Neurobiol. 2005 Jun;76(2):126-52
16115721
Stroke. 2008 Jul;39(7):2021-8
18451352
Lancet. 1991 May 25;337(8752):1235-43
1674060
Brain. 1997 Jan;120 ( Pt 1):141-57
9055804
Behav Neurol. 2007;18(1):45-52
17297219
AJNR Am J Neuroradiol. 2003 Sep;24(8):1501-7
13679259
Stroke. 2001 Mar;32(3):728-34
11239194
J Vasc Surg. 2001 Oct;34(4):587-93
11668309
Nat Rev Neurosci. 2003 Nov;4(11):863-72
14595398
AJNR Am J Neuroradiol. 2005 Mar;26(3):538-42
15760862
Br Med Bull. 1984 Apr;40(2):187-90
6744006
Ann Neurol. 2009 Feb;65(2):203-8
19259970
Stroke. 1998 Aug;29(8):1567-72
9707194
Neurosci Lett. 2001 Aug 10;308(3):141-4
11479008
Glia. 2007 Sep;55(12):1214-21
17659528
Proc Natl Acad Sci U S A. 1990 Dec;87(24):9868-72
2124706
Radiology. 2008 Oct;249(1):251-8
18796680