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AJNR Awards, New Junior Editors, and more. Read the latest AJNR updates

Research ArticleINTERVENTIONAL

Carotid Stent Delivery in an XMR Suite: Immediate Assessment of the Physiologic Impact of Extracranial Revascularization

Alastair J. Martin, David A. Saloner, Timothy P. L. Roberts, Heidi Roberts, Oliver M. Weber, William Dillon, Sean Cullen, Van Halbach, Christopher F. Dowd and Randall T. Higashida
American Journal of Neuroradiology March 2005, 26 (3) 531-537;
Alastair J. Martin
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David A. Saloner
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Timothy P. L. Roberts
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Heidi Roberts
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Oliver M. Weber
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William Dillon
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Sean Cullen
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Van Halbach
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Christopher F. Dowd
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Randall T. Higashida
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Article Figures & Data

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  • Fig 1.
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    Fig 1.

    An XMR suite coupling an MR imaging scanner (background) with a catheterization lab (foreground). The patient lies on a floating tabletop that moves between the two systems on a continuous track. Magnetic isocenter and the conventional radiographic imaging position are separated by 6 m, and patients can be transferred between these two stations in less than 1 minute.

  • Fig 2.
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    Fig 2.

    A very high-grade stenosis of the ICA depicted via 3DRA (A). Tight stenoses such as this could not be directly depicted with CE-MRA, although the presence of downstream contrast and measurable flow provide evidence of residual patency. B, Magnitude (top) and phase (bottom) MR images demonstrating the ICA (arrows) just distal to the stenosis, where the phase image reveals small, but nonzero, flow.

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    Fig 3.

    Measurement of flow changes within neck arteries is demonstrated. A, Section positioning (line) was performed on CE-MRA data such that the section was approximately perpendicular to the vessels and just distal or proximal to the stenosis (arrow). Qflow measurements were then performed at this site immediately before (B) and following (C) stent placement. Shown are the magnitude (left) and phase (right) images demonstrating the reproducibility of the scan plane and the increase in flow in the stented artery (arrows).

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    Fig 4.

    rCBV (left column) and TTP (right column) images obtained immediately before (top row) and following (bottom row) placement of a stent in the patient’s left carotid artery. Initially the ipsilateral hemisphere exhibited delayed arrival times, but this reversed following treatment. The patient’s contralateral ICA was also somewhat stenotic, and this may be responsible for the inversion following stent placement.

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    Fig 5.

    Turbo-FLAIR imaging performed before treatment (left) and immediately following (right) placement of a stent in the left carotid artery. Following treatment, substantial enhancement of the CSF is evident but spatially limited to the ipsilateral hemisphere. The pretreatment turbo-FLAIR was performed shortly after the administration of contrast but did not exhibit CSF enhancement.

Tables

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    TABLE 1:

    Patient summaries

    PatientAgeStenosis SeveritySymptomaticTFLR Enhancement
    14999YesStrong
    28699NoNo
    34792YesSlight
    46299YesSlight
    55180YesSlight
    66580NoStrong
    77878NoNo
    88070YesStrong
    96891NoNo
    105290NoStrong
    116882NoSlight
    127695YesSlight
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    TABLE 2:

    Flow changes prior to and immediately following stent placement

    VesselFlow − pre (mL/s)Flow − post (mL/s)Flow (mL/s)
    Ipsilateral ICA2.5 ± 1.24.7 ± 1.4+2.2 ± 1.2
    Contralateral ICA4.7 ± 2.04.9 ± 2.1+0.2 ± 0.8
    Posterior circulation3.3 ± 1.03.8 ± 1.6+0.3 ± 0.9
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    TABLE 3:

    Perfusion changes following stent placement

    HemisphereCBVMTTT0TTP
    Ipsilateral+6% ± 20%−1.4 ± 1.1 s+1.0 ± 1.1 s−1.1 ± 1.5 s
    Contralateral+6% ± 17%−0.6 ± 1.4 s+0.4 ± 1.2 s−0.3 ± 1.9 s
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American Journal of Neuroradiology: 26 (3)
American Journal of Neuroradiology
Vol. 26, Issue 3
1 Mar 2005
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Cite this article
Alastair J. Martin, David A. Saloner, Timothy P. L. Roberts, Heidi Roberts, Oliver M. Weber, William Dillon, Sean Cullen, Van Halbach, Christopher F. Dowd, Randall T. Higashida
Carotid Stent Delivery in an XMR Suite: Immediate Assessment of the Physiologic Impact of Extracranial Revascularization
American Journal of Neuroradiology Mar 2005, 26 (3) 531-537;

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Carotid Stent Delivery in an XMR Suite: Immediate Assessment of the Physiologic Impact of Extracranial Revascularization
Alastair J. Martin, David A. Saloner, Timothy P. L. Roberts, Heidi Roberts, Oliver M. Weber, William Dillon, Sean Cullen, Van Halbach, Christopher F. Dowd, Randall T. Higashida
American Journal of Neuroradiology Mar 2005, 26 (3) 531-537;
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