ASL perfusion features and type of circle of Willis as imaging markers for cerebral hyperperfusion after carotid revascularization: a preliminary study
Cerebral hyperperfusion (CH) could be a disastrous outcome causing complication after carotid revascularization if not managed properly and timely. The aim of this study was to investigate the association between preoperative arterial spin labelling (ASL) perfusion features and circle of Willis (CoW) pattern with CH.
Forty-eight consecutive carotid stenosis patients who underwent carotid endarterectomy (CEA) or carotid artery stenting (CAS) were enrolled. All patients had single post-labelling delay (PLD) ASL, territory-ASL, and 3-dimensional time-of-flight MR angiography (3D TOF MRA) within 2 weeks before surgery and within 3 days after surgery. Spatial coefficient of variation (CoV) of cerebral blood flow (CBF), whole brain, and territory perfusion volume ratio were calculated from ASL and territory-ASL. Postoperative CoW was classified into two groups based on patency of the first segment of the anterior cerebral arteries (A1) and anterior communicating artery (AcomA). ASL perfusion features, type of CoW, and clinical characteristics were analyzed between CH group and non-CH group to identify CH risk factors.
Higher CoV (p = 0.005) of CBF, lower whole brain perfusion volume ratio (p = 0.012), missing any of A1 or AcomA in CoW (p = 0.002 for postoperative MRA and p = 0.004 for preoperative MRA), and large artery stroke history (p = 0.028) were significantly associated with higher risk of CH. Two cases with cerebral hyperperfusion syndrome (CHS) were also discussed, and their perfusion and angiographic features were shown.
Single-PLD ASL and MRA might be useful and non-invasive imaging tools to identify patients with higher risk of CH after carotid revascularization.
• Cerebral hyperperfusion is a critical complication after carotid endarterectomy or carotid artery stenting.
• ASL and MRA can be used to identify patients at higher risk of cerebral hyperperfusion
• Pattern of circle of Willis, ASL perfusion features, and whole brain perfusion volume ratio are potential predicting markers for hyperperfusion after carotid revascularization.
KeywordsCarotid stenosis Vascular surgical procedures Magnetic resonance imaging Spin labels Circle of Willis
- 3D TOF MRA
3-dimensional time-of-flight MR angiography
First segment of the anterior cerebral artery
Anterior communicating artery
Arterial transit time
3-dimensional T1-weighted inversion-prepared fast spoiled gradient echo
Carotid artery stenting
Cerebral blood flow
Cerebral hyperperfusion syndrome
Spatial coefficient of variation
Circle of Willis
Dynamic susceptibility contrast
Fluid-attenuated inversion recovery
Internal carotid artery
This work was supported in part by the Ministry of Science and Technology of China grant (2015CB351701) and the National Nature Science Foundation of China grant (31730039). This work also received funding from Peking Union Medical College.
Compliance with ethical standards
The scientific guarantor of this publication is Feng Feng.
Conflict of interest
The authors declare that they have no conflict of interest.
Statistics and biometry
No complex statistical methods were necessary for this paper.
Written informed consent was obtained from all subjects (patients) in this study.
Institutional Review Board approval was obtained.
Study subjects or cohorts overlap
Some study subjects or cohorts have been previously reported in “Effective collateral circulation may indicate improved perfusion territory restoration after carotid endarterectomy. 2018. Eur Radiol 28:727–735.”, and as a poster “Preoperative predictors of hyperperfusion after CEA: a study using vessel selective ASL” in ISMRM 2018.
• performed at one institution
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