New-onset lesions on MRI-DWI and cerebral blood flow changes on 3D-pCASL after carotid artery stenting

• Published in: Scientific reports Vol. 11; no. 1; pp. 8005 - 7
• Main Authors: Wang, Wen-Xin, Wang, Ting, Ma, Lin, Sun, Zheng-Hui, Wang, Ge-Sheng
• Format: Journal Article
• Language: English
• Published: England Nature Publishing Group 13.04.2021; Nature Publishing Group UK; Nature Portfolio
• Subjects: Aged; Aged, 80 and over; Blood flow; Blood pressure; Carotid arteries; Carotid Arteries - diagnostic imaging; Carotid Arteries - pathology; Carotid Arteries - physiopathology; Carotid Arteries - surgery; Carotid artery; Carotid Stenosis - diagnostic imaging; Carotid Stenosis - physiopathology; Carotid Stenosis - surgery; Cerebral blood flow; Cerebrovascular Circulation; Diffusion Magnetic Resonance Imaging - methods; Embolism; Embolisms; Female; Hemodynamics; Humans; Imaging, Three-Dimensional; Lesions; Magnetic resonance imaging; Male; Middle Aged; Neuroimaging; Patients; Spin labeling; Stenosis; Stents - adverse effects; Surgery; Temporal lobe; Veins & arteries
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-021-87339-z

This study aimed to investigate the relationship between the new-onset hyperintense lesions on diffusion-weighted images (DWI) and the changes of cerebral blood flow (CBF) before and after carotid artery stenting (CAS) in patients with symptomatic unilateral carotid artery stenosis. Twenty-four patients with symptomatic unilateral carotid stenosis (50-99%) were enrolled. Routine head magnetic resonance imaging and three-dimensional pseudo-continuous arterial spin labeling were taken 7 days before the surgery and for four consecutive days post CAS. While the incidence of new DWI lesions were high (17/24, 70.8%) and 176 lesions were observed among the 17 cases, there was only one subject showing the symptoms. The majority of the lesions were located at the cortex/subcortex of the ipsilateral frontal and parietal lobes (60.8%) with 92.6% of the lesions size being less than 3 mm. The CBFs in this area were significantly higher than that of the temporal lobe on the first 3 days post stenting (p < 0.05). No periprocedural CBF differences were observed between the two groups, however, the micro-embolism group presented decreased relative CBF in frontal and parietal lobes prior to stenting compared with the non-embolism group. The systolic blood pressure in the micro-embolism group at discharge was significantly lower than that at admission. The high incidence rate of micro-embolism in patients receiving CAS may not be the result of direct changes of hemodynamics in the brain but rather the loss of CBF regulation due to long-term hypoperfusion prior to the stenting.