Quantitative magnetic resonance angiography as a potential predictor for cerebral hyperperfusion syndrome: a preliminary study.

Andereggen, Lukas; Amin-Hanjani, Sepideh; El-Koussy, Marwan; Verma, Rajeev Kumar; Yuki, Kenya; Schöni, Daniel Stephan; Hsieh, Kety Wha-Vei; Gralla, Jan; Schroth, Gerhard; Beck, Jürgen; Raabe, Andreas; Arnold, Marcel; Reinert, Michael; Andres, Robert (2018). Quantitative magnetic resonance angiography as a potential predictor for cerebral hyperperfusion syndrome: a preliminary study. Journal of neurosurgery, 128(4), pp. 1006-1014. American Association of Neurological Surgeons 10.3171/2016.11.JNS161033

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OBJECTIVE Cerebral hyperperfusion syndrome (CHS) is a rare but devastating complication of carotid endarterectomy (CEA). This study sought to determine whether quantitative hemodynamic assessment using MR angiography can stratify CHS risk. METHODS In this prospective trial, patients with internal carotid artery (ICA) stenosis were randomly selected for pre- and postoperative quantitative phase-contrast MR angiography (QMRA). Assessment was standardized according to a protocol and included Doppler/duplex sonography, MRI, and/or CT angiography and QMRA of the intra- and extracranial supplying arteries of the brain. Clinical and radiological data were analyzed to identify CHS risk factors. RESULTS Twenty-five of 153 patients who underwent CEA for ICA stenosis were randomly selected for pre- and postoperative QMRA. QMRA data showed a 2.2-fold postoperative increase in blood flow in the operated ICA (p < 0.001) and a 1.3-fold increase in the ipsilateral middle cerebral artery (MCA) (p = 0.01). Four patients had clinically manifested CHS. The mean flow increases in the patients with CHS were significantly higher than in the patients without CHS, both in the ICA and MCA (p < 0.001). Female sex and a low preoperative diastolic blood pressure were the clearest clinical risk factors for CHS, whereas the flow differences and absolute postoperative flow values in the ipsilateral ICA and MCA were identified as potential radiological predictors for CHS. CONCLUSIONS Cerebral blood flow in the ipsilateral ICA and MCA as assessed by QMRA significantly increased after CEA. Higher mean flow differences in ICA and MCA were associated with the development of CHS. QMRA might have the potential to become a noninvasive, operator-independent screening tool for identifying patients at risk for CHS.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurosurgery

UniBE Contributor:

Andereggen, Lukas; El-Koussy, Marwan; Verma, Rajeev Kumar; Schöni, Daniel Stephan; Hsieh, Kety Wha-Vei; Gralla, Jan; Schroth, Gerhard; Beck, Jürgen; Raabe, Andreas; Arnold, Marcel; Reinert, Michael and Andres, Robert

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0022-3085

Publisher:

American Association of Neurological Surgeons

Language:

English

Submitter:

Martin Zbinden

Date Deposited:

08 Aug 2017 08:27

Last Modified:

04 Apr 2018 01:30

Publisher DOI:

10.3171/2016.11.JNS161033

PubMed ID:

28409735

Uncontrolled Keywords:

ASA = acetylsalicylic acid; AUC = area under the receiver operating characteristic curve; CBF = cerebral blood flow; CEA = carotid endarterectomy; CHS = cerebral hyperperfusion syndrome; ICA = internal carotid artery; MCA = middle cerebral artery; NOVA = noninvasive optimal vessel analysis; QMRA = quantitative phase-contrast MR angiography; TCD = transcranial Doppler; carotid endarterectomy; cerebral blood flow; hyperperfusion syndrome; mRS = modified Rankin Scale; quantitative phase-contrast MR angiography; transcranial Doppler; vascular disorders

URI:

https://boris.unibe.ch/id/eprint/99471

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