title: Normalization of cerebral vasoreactivity using BOLD MRI after intravascular stenting.
abstract: OBJECTIVE
  Intravascular angioplasty and stenting of intracranial arterial stenosis provided controversial results. Besides the expertise of the practitioners, the selection of the patients remains challenging. BOLD MRI of the cerebral vasoreactivity (BOLD MRI CVR) to hypercapnia provides reproducible maps of the entire brain of the vascular reserve, and could be helpful to assess the best therapeutic strategy.
  
  
  METHODS
  We report the case of a 63-year-old woman referred for a severe stenosis of the proximal portion of the left middle cerebral artery, revealed by a lenticulostriate and precentral infarction. Despite an aggressive medical treatment during 5 months, the occurrence of iterative transient ischemic attacks motivated intravascular stenting. Functional MRI of the vasoreactivity to hypercapnia using both Blood Oxygen Level Dependent (BOLD) and arterial spin labeling sequences showed normal basal perfusion and impaired vasoreactivity in the left middle cerebral artery territory. Three months after stenting, the BOLD MRI CVR showed vasoreactivity normalization. Since, the patient remains free of ischemic disorders one year after stenting.
  
  
  CONCLUSIONS
  BOLD MRI of the CVR to hypercapnia may be helpful to optimize the treatment of patients with intracranial arterial stenosis, and could be performed in future therapeutic trials.
authors: Department of Neuroradiology and MRI, University Hospital of Grenoble-IFR1, Grenoble, France; Inserm, U836, Grenoble, France; Université Joseph Fourier, Grenoble Institute of Neurosciences UMR-S836, Grenoble, France.
authors: Arnaud
authors: A
authors: Attyé
authors: Marjorie
authors: M
authors: Villien
authors: Florence
authors: F
authors: Tahon
authors: Jan
authors: J
authors: Warnking
authors: Olivier
authors: O
authors: Detante
authors: Alexandre
authors: A
authors: Krainik
mesh_terms: D001921:Brain / Q000098:blood supply / Q000503:physiopathology* / Q000601:surgery*; D020520:Brain Infarction / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D001931:Brain Mapping; D002533:Cerebral Angiography; D002539:Cerebral Arterial Diseases / Q000150:complications / Q000503:physiopathology / Q000601:surgery; D002560:Cerebrovascular Circulation / Q000502:physiology*; D003251:Constriction, Pathologic / Q000601:surgery; D005260:Female; D006801:Humans; D006935:Hypercapnia / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000503:physiopathology; D010100:Oxygen / Q000097:blood*; D015607:Stents; D016896:Treatment Outcome
chemical_list: D010100:Oxygen
keywords: BOLD MRI; cerebral vasoreactivity; hypercapnia; intracranial stenosis; intravascular stenting; transient ischaemic attack