• Acta radiologica · Jun 2015

    Hemodynamic alterations in unilateral chronic middle cerebral artery stenosis patients and the effect of percutaneous transluminal angioplasty and stenting: a perfusion-computed tomography study.

    • Xiao Qing Cheng, Jian Ming Tian, Chang Jing Zuo, Long Jiang Zhang, Chang Sheng Zhou, Yan E Zhao, Song Luo, Qi Zhang, and Guang Ming Lu.
    • Department of Medical Imaging, Jinling Hospital, Clinical School of Medical College, Nanjing University, Nanjing, Jiangsu Province, PR China.
    • Acta Radiol. 2015 Jun 1; 56 (6): 754-60.

    BackgroundThe Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) trial indicated that most patients with symptomatic intracranial atherosclerosis are not good candidates for percutaneous transluminal angioplasty and stenting (PTAS) because of a higher complication risk than with conservative treatment. However, enrollment of SAMMPRIS patients was based on lesion severity only, without functional imaging.PurposeTo determine whether perfusion computed tomography (PCT) can effectively evaluate hemodynamic compromise in unilateral chronic middle cerebral artery stenosis and the alterations of hemodynamics after PTAS.Material And MethodsIn this prospective study, 89 patients with unilateral middle cerebral artery (MCA) stenosis/occlusion were enrolled and classified into four groups according to the degree of stenosis. Cerebral hemodynamics was evaluated by measuring cerebral blood flow (CBF), cerebral blood volume (CBV), and time to peak (TTP) in the ipsilateral and contralateral hemispheres by PCT before and after intervention with PTAS. Differences in hemodynamic parameters before and after intervention were analyzed.ResultsThree different hemodynamic patterns were observed in these patients. Patients with severe MCA stenosis (70-99%) or MCA occlusion demonstrated a significant increase of ipsilateral CBV and TTP, indicating hemodynamic compromise. Ten severe stenosis patients with recurrent ischemic symptoms despite of maximal conservative therapy were selected for PTAS. PTAS induced a rapid recovery of cerebral hemodynamics (especially TTP) at 1 week post intervention.ConclusionPCT appears to be a valuable noninvasive technique to evaluate hemodynamic compromise in unilateral chronic MCA stenosis and the improvements after PTAS.© The Foundation Acta Radiologica 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

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