title: Hemodynamic alterations in unilateral chronic middle cerebral artery stenosis patients and the effect of percutaneous transluminal angioplasty and stenting: a perfusion-computed tomography study.
abstract: BACKGROUND
  The Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) trial indicated that most patients with symptomatic intracranial atherosclerosis are not good candidates for percutaneous transluminal angioplasty and stenting (PTAS) because of a higher complication risk than with conservative treatment. However, enrollment of SAMMPRIS patients was based on lesion severity only, without functional imaging.
  
  
  OBJECTIVE
  To determine whether perfusion computed tomography (PCT) can effectively evaluate hemodynamic compromise in unilateral chronic middle cerebral artery stenosis and the alterations of hemodynamics after PTAS.
  
  
  METHODS
  In this prospective study, 89 patients with unilateral middle cerebral artery (MCA) stenosis/occlusion were enrolled and classified into four groups according to the degree of stenosis. Cerebral hemodynamics was evaluated by measuring cerebral blood flow (CBF), cerebral blood volume (CBV), and time to peak (TTP) in the ipsilateral and contralateral hemispheres by PCT before and after intervention with PTAS. Differences in hemodynamic parameters before and after intervention were analyzed.
  
  
  RESULTS
  Three different hemodynamic patterns were observed in these patients. Patients with severe MCA stenosis (70-99%) or MCA occlusion demonstrated a significant increase of ipsilateral CBV and TTP, indicating hemodynamic compromise. Ten severe stenosis patients with recurrent ischemic symptoms despite of maximal conservative therapy were selected for PTAS. PTAS induced a rapid recovery of cerebral hemodynamics (especially TTP) at 1 week post intervention.
  
  
  CONCLUSIONS
  PCT appears to be a valuable noninvasive technique to evaluate hemodynamic compromise in unilateral chronic MCA stenosis and the improvements after PTAS.
authors.affiliation: Department of Medical Imaging, Jinling Hospital, Clinical School of Medical College, Nanjing University, Nanjing, Jiangsu Province, PR China.
authors.forename: Xiao Qing
authors.initials: XQ
authors.lastname: Cheng
authors.affiliation: Department of Medical Imaging, Changhai Hospital, The 2nd Military Medical University, Shanghai, PR China.
authors.forename: Jian Ming
authors.initials: JM
authors.lastname: Tian
authors.affiliation: Department of Nuclear Medicine, Changhai Hospital, The 2nd Military Medical University, Shanghai, PR China.
authors.forename: Chang Jing
authors.initials: CJ
authors.lastname: Zuo
authors.affiliation: Department of Medical Imaging, Jinling Hospital, Clinical School of Medical College, Nanjing University, Nanjing, Jiangsu Province, PR China.
authors.forename: Long Jiang
authors.initials: LJ
authors.lastname: Zhang
authors.affiliation: Department of Medical Imaging, Jinling Hospital, Clinical School of Medical College, Nanjing University, Nanjing, Jiangsu Province, PR China.
authors.forename: Chang Sheng
authors.initials: CS
authors.lastname: Zhou
authors.affiliation: Department of Medical Imaging, Jinling Hospital, Clinical School of Medical College, Nanjing University, Nanjing, Jiangsu Province, PR China.
authors.forename: Yan E
authors.initials: YE
authors.lastname: Zhao
authors.affiliation: Department of Medical Imaging, Jinling Hospital, Clinical School of Medical College, Nanjing University, Nanjing, Jiangsu Province, PR China.
authors.forename: Song
authors.initials: S
authors.lastname: Luo
authors.affiliation: Department of Neurosurgery, Changhai Hospital, The 2nd Military Medical University, Shanghai, PR China.
authors.forename: Qi
authors.initials: Q
authors.lastname: Zhang
authors.affiliation: Department of Medical Imaging, Jinling Hospital, Clinical School of Medical College, Nanjing University, Nanjing, Jiangsu Province, PR China cjr.luguangming@vip.163.com.
authors.forename: Guang Ming
authors.initials: GM
authors.lastname: Lu
mesh_terms: D017130:Angioplasty; D002560:Cerebrovascular Circulation; D003251:Constriction, Pathologic; D005260:Female; D006439:Hemodynamics; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015607:Stents; D014057:Tomography, X-Ray Computed
keywords: PTAS; Perfusion CT; hemodynamic; middle cerebral artery; stenosis; stroke; time to peak