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Case Reports
. 2014 Apr;35(4):1320-4.
doi: 10.1002/hbm.22255. Epub 2013 Feb 21.

Normalization of cerebral vasoreactivity using BOLD MRI after intravascular stenting

Arnaud Attyé  1 , Marjorie Villien, Florence Tahon, Jan Warnking, Olivier Detante, Alexandre Krainik
Affiliations
Case Reports

Normalization of cerebral vasoreactivity using BOLD MRI after intravascular stenting

Arnaud Attyé et al. Hum Brain Mapp. 2014 Apr.

Abstract

Background and purpose: Intravascular angioplasty and stenting of intracranial arterial stenosis provided controversial results. Besides the expertise of the practitioners, the selection of the patients remains challenging. BOLD MRI of the cerebral vasoreactivity (BOLD MRI CVR) to hypercapnia provides reproducible maps of the entire brain of the vascular reserve, and could be helpful to assess the best therapeutic strategy.

Case history: We report the case of a 63-year-old woman referred for a severe stenosis of the proximal portion of the left middle cerebral artery, revealed by a lenticulostriate and precentral infarction. Despite an aggressive medical treatment during 5 months, the occurrence of iterative transient ischemic attacks motivated intravascular stenting. Functional MRI of the vasoreactivity to hypercapnia using both Blood Oxygen Level Dependent (BOLD) and arterial spin labeling sequences showed normal basal perfusion and impaired vasoreactivity in the left middle cerebral artery territory. Three months after stenting, the BOLD MRI CVR showed vasoreactivity normalization. Since, the patient remains free of ischemic disorders one year after stenting.

Conclusion: BOLD MRI of the CVR to hypercapnia may be helpful to optimize the treatment of patients with intracranial arterial stenosis, and could be performed in future therapeutic trials.

Keywords: BOLD MRI; cerebral vasoreactivity; hypercapnia; intracranial stenosis; intravascular stenting; transient ischaemic attack.

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Figures

Figure 1
Figure 1
Arteriography showed a severe stenosis of the M1 portion of the left MCA (arrow) before (A) and after successful endovascular stenting (B). In MCA territories, basal perfusion estimated using pseudocontinuous ASL was normal and symmetrical before (C) and after stenting (D), except in the left lenticulostriate infarct. Before endovascular treatment, CVR BOLD MRI of CVR to hypercapnia showed a CVR decrease in the left MCA territory (m ± sd = 0.13 ± 0.07 %BOLD/mm Hg EtCO2) compared to the right MCA territory (0.19 ± 0.07), accounting for a decrease of vascular reserve of 31.6% (E). After treatment, CVR was normalized and symmetrical in the left MCA territory (0.20 ± 0.09) compared to the right MCA territory (0.21 ± 0.08) (F). A persistent CVR decrease was detected in the left posterior junctional area, only.
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References

    1. Bokkers RP, van Osch MJ, et al. (2010). Symptomatic carotid artery stenosis: Impairment of cerebral autoregulation measured at the brain tissue level with arterial spin‐labeling MR imaging. Radiology 256:201–208. - PubMed
    1. Cantin S, Villien M, et al. (2011). Impaired cerebral vasoreactivity to CO2 in Alzheimer's disease using BOLD fMRI. Neuroimage 58:579–587. - PubMed
    1. Chimowitz MI, Lynn MJ, et al. (2005). Comparison of warfarin and aspirin for symptomatic intracranial arterial stenosis. N Engl J Med 352:1305–1316. - PubMed
    1. Chimowitz MI, Lynn MJ, et al. (2011). Stenting versus aggressive medical therapy for intracranial arterial stenosis. N Engl J Med 365:993–1003. - PMC - PubMed
    1. Diener HC, Bogousslavsky J, et al. (2004). Aspirin and clopidogrel compared with clopidogrel alone after recent ischaemic stroke or transient ischaemic attack in high‐risk patients (MATCH): Randomised, double‐blind, placebo‐controlled trial. Lancet 364:331–337. - PubMed

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