title: Reperfusion injury on magnetic resonance imaging after carotid revascularization.
abstract: OBJECTIVE
  Reperfusion injury can be revealed as delayed gadolinium enhancement in the subarachnoid space on a fluid-attenuated inversion recovery image, which is designated as a hyperintense acute reperfusion marker (HARM). We sought to investigate the occurrence and predictors of HARM and its association with new ischemic infarcts after carotid revascularization.
  
  
  METHODS
  Forty-five patients who underwent carotid endarterectomy or stenting were prospectively enrolled. Diffusion-weighted imaging and fluid-attenuated inversion recovery were performed before and 24 hours after the procedures. Postprocedural fluid-attenuated inversion recovery was done after intravenous gadolinium injection.
  
  
  RESULTS
  HARM was observed in 8 (17.8%) patients. Of these, 4 patients showed neurological deterioration associated with HARM. These symptomatic HARMs disappeared on follow-up magnetic resonance imaging. Patients with symptomatic HARM were older (P=0.010) and had more frequent leukoaraiosis (P=0.012) and higher postprocedural systolic blood pressure (P=0.025) than those without. New brain infarcts on postprocedural diffusion-weighted imaging were identified in 13 (28.9%) patients. HARM was not associated with new infarcts.
  
  
  CONCLUSIONS
  HARM after carotid revascularization is not uncommon. Symptomatic HARM was associated with old age, underlying leukoaraiosis, and postprocedural high blood pressure.
authors.affiliation: From the Departments of Neurology (A.-H.C., S.U.K., J.S.K., D.-W.K.), Vascular Surgery (Y.-P.C., T.-W.K.), and Radiology (D.H.L., D.-C.S.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; and Department of Neurology, Catholic University of Korea, College of Medicine, Yeouido St. Mary's Hospital, Seoul, South Korea (A.-H.C.).
authors.forename: A-Hyun
authors.initials: AH
authors.lastname: Cho
authors.forename: Yong-Pil
authors.initials: YP
authors.lastname: Cho
authors.forename: Deok Hee
authors.initials: DH
authors.lastname: Lee
authors.forename: Tae-Won
authors.initials: TW
authors.lastname: Kwon
authors.forename: Sun U
authors.initials: SU
authors.lastname: Kwon
authors.forename: Dae-Chul
authors.initials: DC
authors.lastname: Suh
authors.forename: Jong S
authors.initials: JS
authors.lastname: Kim
authors.forename: Dong-Wha
authors.initials: DW
authors.lastname: Kang
mesh_terms: D000367:Age Factors; D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D002545:Brain Ischemia / Q000473:pathology; D002339:Carotid Arteries / Q000601:surgery*; D002548:Cerebral Revascularization; D003287:Contrast Media; D038524:Diffusion Magnetic Resonance Imaging; D004691:Endarterectomy; D005260:Female; D005682:Gadolinium; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000503:physiopathology; D049292:Leukoaraiosis / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015427:Reperfusion Injury / Q000473:pathology*; D015607:Stents; D013346:Subarachnoid Space / Q000473:pathology
chemical_list: D003287:Contrast Media; D005682:Gadolinium
keywords: cerebral revascularization; reperfusion injury