Progressive changes in cerebral perfusion after carotid stenting: a dynamic susceptibility contrast perfusion weighted imaging study.
BACKGROUND
We aimed to assess baseline inter-hemispheric perfusion differences, before carotid artery stenting (CAS), of severe internal carotid artery (ICA) stenosis, and to evaluate perfusion changes over time after CAS by means of perfusion weighted imaging (PWI).


METHODS
Dynamic susceptibility contrast PWI was performed in 33 patients with severe ICA stenosis 1 day before and 1 day after CAS, and repeated in 23 patients 30 days after CAS. Cerebral blood volume, cerebral blood flow, arrival time (T0), mean transit time, and time to peak (TTP) relative values comparing symptomatic and asymptomatic hemispheres before CAS were obtained. Pre- and post-CAS values were also compared in the treated hemisphere and middle cerebral artery (MCA) territories. The influence of collateral circulation and contralateral ICA stenosis were evaluated.


RESULTS
Before CAS, TTP was significantly increased in the affected hemisphere and MCA territory in all patients (p=0.007 and p=0.021, respectively). After treatment, normalization was observed for TTP and T0 30 days after CAS in all patients, mainly in patients with any grade of contralateral stenosis and with one or both functioning communicating arteries (42.4% of patients had both, and 42.4% showed only one-anterior communicating artery=11 patients (78.6%) and posterior communicating artery=3 patients (21.4%)).


CONCLUSIONS
Inter-hemispheric perfusion differences in patients with severe ICA stenosis normalize after CAS in the long term, up to 30 days after the procedure.
Department of Diagnostic Neuroradiology, Virgen del Rocío University Hospital, Seville, Spain.
Pilar
P
Piñero
Department of Interventional Neuroradiology, Virgen del Rocío University Hospital, Seville, Spain.
Alejandro
A
González
Department of Neurology, Virgen del Rocío University Hospital, Seville, Spain.
Francisco
F
Moniche
Department of Neurology, Infanta Elena Hospital, Huelva, Spain.
Eva
E
Martínez
Department of Medical Research, Virgen del Rocío University Hospital, Seville, Spain.
Aurelio
A
Cayuela
Department of Neurology, Virgen del Rocío University Hospital, Seville, Spain.
José-Ramón
JR
González-Marcos
Department of Interventional Neuroradiology, Virgen del Rocío University Hospital, Seville, Spain.
Antonio
A
Mayol
Department of Neurology, Virgen del Rocío University Hospital, Seville, Spain.
Alberto
A
Gil-Peralta
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002339:Carotid Arteries / Q000503:physiopathology / Q000601:surgery*; D016893:Carotid Stenosis / Q000503:physiopathology / Q000601:surgery*; D002560:Cerebrovascular Circulation; D005260:Female; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000473:pathology / Q000601:surgery; D059906:Neuroimaging; D015607:Stents; D016896:Treatment Outcome
Atherosclerosis; Blood Flow; MR perfusion; Stent