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Updated: May 4, 2026
A Magnetic Resonance Imaging Protocol for Stroke Onset Time Estimation in Permanent Cerebral Ischemia
Published on: September 16, 2017
Reperfusion injury on magnetic resonance imaging after carotid revascularization
A-Hyun Cho1, Yong-Pil Cho, Deok Hee Lee
1From the Departments of Neurology (A.-H.C., S.U.K., J.S.K., D.-W.K.), Vascular Surgery (Y.-P.C., T.-W.K.), and Radiology (D.H.L., D.-C.S.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; and Department of Neurology, Catholic University of Korea, College of Medicine, Yeouido St. Mary's Hospital, Seoul, South Korea (A.-H.C.).
Background And Purpose:
Reperfusion injury can be revealed as delayed gadolinium enhancement in the subarachnoid space on a fluid-attenuated inversion recovery image, which is designated as a hyperintense acute reperfusion marker (HARM). We sought to investigate the occurrence and predictors of HARM and its association with new ischemic infarcts after carotid revascularization.
Methods:
Forty-five patients who underwent carotid endarterectomy or stenting were prospectively enrolled. Diffusion-weighted imaging and fluid-attenuated inversion recovery were performed before and 24 hours after the procedures. Postprocedural fluid-attenuated inversion recovery was done after intravenous gadolinium injection.
Results:
HARM was observed in 8 (17.8%) patients. Of these, 4 patients showed neurological deterioration associated with HARM. These symptomatic HARMs disappeared on follow-up magnetic resonance imaging. Patients with symptomatic HARM were older (P=0.010) and had more frequent leukoaraiosis (P=0.012) and higher postprocedural systolic blood pressure (P=0.025) than those without. New brain infarcts on postprocedural diffusion-weighted imaging were identified in 13 (28.9%) patients. HARM was not associated with new infarcts.
Conclusions:
HARM after carotid revascularization is not uncommon. Symptomatic HARM was associated with old age, underlying leukoaraiosis, and postprocedural high blood pressure.
