Abstract
BACKGROUND AND PURPOSE: Significant extracranial stenosis of the ICA is a known risk factor for future stroke and it has been shown that revascularization reduces the risk of future stroke. We applied BOLD fMRI in patients with carotid artery stenosis before and after CEA. Our purpose was to determine whether fMRI is able to demonstrate impaired CVR and to identify patient parameters that are associated with postoperative changes of cerebral hemodynamics.
MATERIALS AND METHODS: Nineteen consecutive patients with symptomatic (n = 13) and asymptomatic (n = 6) stenosis of the ICA were prospectively recruited (male/female ratio = 16:3; age, 69 ± 8,1 years). fMRI using a simple bilateral motor task was performed immediately before and after CEA.
RESULTS: Mean BOLD MSC was significantly increased postoperatively (MSC, 0.13 ± 0.66; P = 0.0002). Patients with a stenosis of <80% demonstrated an increase in MSC (MSC, 0.32 ± 0.59; P ≤ .0001). Patients with previous ischemic stroke showed a larger MSC than patients with TIAs (stroke: MSC, 0.55 ± 0.65; P ≤ .0001; TIA: MSC, 0.05 ± 0.26; P = 0.054). Patients older than 70 years had a significantly larger MSC following surgery (≤70 years: MSC, −0.01 ± 0.39; P = .429; >70 years: MSC, 0.29 ± 0.48; P ≤ .0001).
CONCLUSIONS: BOLD fMRI can demonstrate changes in cerebral hemodynamics before and after CEA, indicative of an ameliorated CVR. This response is dependent on the age of the patient, the degree of preoperative stenosis, and the patient's symptoms.
Abbreviations
- AF
- amaurosis fugax
- asymp
- asymptomatic
- BOLD
- blood oxygen level–dependent
- CBF
- cerebral blood flow
- CBV
- cerebral blood volume
- CEA
- carotid endarterectomy
- CO2
- carbon dioxide
- CPP
- cerebral perfusion pressure
- CVR
- cerebrovascular reactivity
- DWI
- diffusion-weighed imaging
- FLAIR
- fluid-attenuated inversion recovery
- fMRI
- functional MR imaging
- ICA
- internal carotid artery
- MRI
- MR imaging
- MSC
- mean SC
- N/A
- not applicable
- Pre
- before
- Post
- after
- SC
- signal-intensity change
- symp
- symptomatic
- T2WI
- T2-weighted imaging
- TIA
- transient ischemic attack
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