Assessment of Cerebral Vasodilatory Capacity as Part of Catheter-Based Cerebral Angiography

• Published in: Journal of neuroimaging Vol. 30; no. 1; p. 90
• Main Authors: Qureshi, Adnan I, Asif, Ahmer, Waqas, Muhammad A, Aytac, Emrah, Gurkas, Erdem, Saleem, Muhammad A, Wallery, Shawn S
• Format: Journal Article
• Language: English
• Published: United States 01.01.2020
• Subjects: Aged; Carotid Artery, Internal - diagnostic imaging; Carotid Artery, Internal - physiopathology; Carotid Stenosis - diagnostic imaging; Carotid Stenosis - physiopathology; Cerebral Angiography - methods; Cerebrovascular Circulation - physiology; Contrast Media; Female; Humans; Male; Middle Aged; Risk Assessment; Severity of Illness Index; Vasodilation - physiology; Vertebral Artery - diagnostic imaging; Vertebral Artery - physiopathology; Vertebrobasilar Insufficiency - diagnostic imaging; Vertebrobasilar Insufficiency - physiopathology; nicardipine; vasodilatory capacity; regional cerebral blood volume; angiography
• ISSN: 1552-6569
• DOI: 10.1111/jon.12665

Cerebral vasodilatory capacity assessment for risk stratification in patients with extracranial arterial stenosis or occlusion may be useful. We describe a new method that assesses cerebral vasodilatory capacity as part of catheter-based cerebral angiography. We prospectively assessed regional cerebral blood volume (rCBV) in the arterial distribution of interest using a controlled contrast injection in the common carotid or the subclavian arteries. rCBV maps were created using a predefined algorithm based on contrast distribution in the venous phase (voxel size: .466 mm ). rCBV maps were acquired again after selective administration of intra-arterial nicardipine (2.0 mg) distal to the stenosis. Two independent observers graded the change in rCBV in 10 predefined anatomical regions within the tributaries of the artery of interest (0 = reduction, 1 = no change, 2 = increase) and total rCBV change scores were summated. Twenty-five patients with internal carotid artery stenosis (n = 18; 0-90% in severity) or extracranial vertebral artery stenosis (n = 7; 0-100% in severity) were assessed. There was an increase in rCBV in a tributary of the artery of interest in 18 of 25 after intra-arterial nicardipine (mean score: 11.98; range 0-19.5). There was no change or decrease in rCBV in 7 of 25 patients. The mean rCBV change score was similar in patients with an assessment of internal carotid artery or vertebral artery distributions (12.2 ± 5.3; 11.4 ± 2.5; P = .68). Selective vasodilatory response to intra-arterial nicardipine in the affected arterial distribution during catheter-based cerebral angiography may provide new data for risk stratification.