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Reduced cerebrovascular reserve at CO2 BOLD MR imaging is associated with increased risk of periinterventional ischemic lesions during carotid endarterectomy or stent placement: preliminary results

Haller, S. and Bonati, L. H. and Rick, J. and Klarhöfer, M. and Speck, O. and Lyrer, P. A. and Bilecen, D. and Engelter, S. T. and Wetzel, S. G.. (2008) Reduced cerebrovascular reserve at CO2 BOLD MR imaging is associated with increased risk of periinterventional ischemic lesions during carotid endarterectomy or stent placement: preliminary results. Radiology, Vol. 249. pp. 251-258.

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Official URL: http://edoc.unibas.ch/dok/A6004873

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Abstract

PURPOSE: To determine whether any initial reductions in cardiovascular reserve (CVR) normalize after carotid revascularization and-because reduced CVR represents a risk factor for ischemic events-whether patients who develop periinterventional infarction have more severely reduced pretreatment CVR than those who do not. MATERIALS AND METHODS: Ethics committee approval and informed consent were obtained. Twenty-four consecutive patients with symptomatic high-grade internal carotid artery stenosis (seven women; mean age, 73.1 years +/- 9.4 [standard deviation]) were recruited from a prospective, randomized trial that compared carotid artery stent placement with endarterectomy. Magnetic resonance (MR) imaging, including CO(2) blood oxygen level-dependent (BOLD) MR, was performed 1-3 days before, 1-3 days after, and 1 month after carotid revascularization (carotid artery stent placement, n = 13; carotid endarterectomy, n = 11). RESULTS: Mean CVR in the ipsilateral middle cerebral artery (MCA) territory was reduced prior to treatment (mean DeltaT2* in ipsilateral territory, 1.92% +/- 1.18; mean DeltaT2* in contralateral territory, 2.28% +/- 1.15 [P .05]; mean DeltaT2* 1 month after treatment in ipsilateral territory, 2.27% +/- 1.05; that in contralateral territory, 2.14% +/- 0.96 [P < .05]). Those patients who developed new periinterventional infarcts (n = 7 with punctate foci of restricted diffusion) had greater reduction of CVR in the ipsilateral MCA territory prior to treatment (relative reduction, 32.5% +/- 46.0; P > .05) than those who did not develop infarction (n = 17; relative reduction, 9.2% +/- 55.9). CONCLUSION: CO(2) BOLD MR imaging could be used successfully to monitor the hemodynamic effects of carotid revascularization; initial reductions in CVR normalized after carotid revascularization. Severely reduced pretreatment CVR was associated with increased occurrence of new periinterventional therapy infarction.
Faculties and Departments:03 Faculty of Medicine > Bereich Querschnittsfächer (Klinik) > Radiologie USB
03 Faculty of Medicine > Departement Klinische Forschung > Bereich Querschnittsfächer (Klinik) > Radiologie USB
03 Faculty of Medicine > Bereich Medizinische Fächer (Klinik) > Neurologie
03 Faculty of Medicine > Departement Klinische Forschung > Bereich Medizinische Fächer (Klinik) > Neurologie
UniBasel Contributors:Lyrer, Philippe A. and Bilecen, Deniz and Engelter, Stefan
Item Type:Article, refereed
Article Subtype:Research Article
Bibsysno:Link to catalogue
Publisher:The Radiological Society of North America
ISSN:0033-8419
Note:Publication type according to Uni Basel Research Database: Journal article
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Last Modified:08 Nov 2012 16:09
Deposited On:11 Oct 2012 15:30

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