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Protocol for Isolating the Mouse Circle of Willis
Published on: October 22, 2016
ASL perfusion features and type of circle of Willis as imaging markers for cerebral hyperperfusion after carotid
Tianye Lin1, Zhichao Lai2, Zhentao Zuo3
1Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan, Beijing, China.
Insights
Arterial spin labelling (ASL) and MR angiography can identify patients at high risk for cerebral hyperperfusion (CH) after carotid revascularization. Preoperative imaging features, including circle of Willis patterns, predict CH complications.
Area of Science:
- Neurology
- Radiology
- Vascular Surgery
Background:
- Cerebral hyperperfusion (CH) is a serious complication following carotid revascularization procedures like endarterectomy (CEA) and stenting (CAS).
- Timely and proper management is crucial to prevent adverse outcomes associated with CH.
- Identifying patients at risk preoperatively is essential for proactive management strategies.
Purpose of the Study:
- To investigate the association between preoperative arterial spin labelling (ASL) perfusion characteristics and circle of Willis (CoW) patterns with the risk of developing CH.
- To identify imaging biomarkers that can predict CH after carotid revascularization.
- To analyze risk factors for CH in patients undergoing CEA or CAS.
Main Methods:
- Forty-eight patients with carotid stenosis undergoing CEA or CAS were included.
- Preoperative and postoperative ASL and 3D TOF MRA were performed.
- Analysis included spatial coefficient of variation (CoV) of cerebral blood flow (CBF), perfusion volume ratios, and CoW patterns (A1 and AcomA patency).
Main Results:
- Higher CBF CoV and lower whole brain perfusion volume ratio were associated with increased CH risk.
- Incomplete CoW patterns (missing A1 or AcomA) significantly correlated with higher CH risk.
- History of large artery stroke was also a risk factor for CH.
Conclusions:
- Single-post-labelling delay (PLD) ASL and MRA are valuable non-invasive tools for identifying patients at higher risk of CH.
- CoW pattern, ASL perfusion features, and whole brain perfusion volume ratio are potential predictive markers for postoperative hyperperfusion.
- These imaging findings can aid in risk stratification and management planning for carotid revascularization.
Objectives:
Cerebral hyperperfusion (CH) could be a disastrous outcome causing complication after carotid revascularization if not managed properly and timely. The aim of this study was to investigate the association between preoperative arterial spin labelling (ASL) perfusion features and circle of Willis (CoW) pattern with CH.
Methods:
Forty-eight consecutive carotid stenosis patients who underwent carotid endarterectomy (CEA) or carotid artery stenting (CAS) were enrolled. All patients had single post-labelling delay (PLD) ASL, territory-ASL, and 3-dimensional time-of-flight MR angiography (3D TOF MRA) within 2 weeks before surgery and within 3 days after surgery. Spatial coefficient of variation (CoV) of cerebral blood flow (CBF), whole brain, and territory perfusion volume ratio were calculated from ASL and territory-ASL. Postoperative CoW was classified into two groups based on patency of the first segment of the anterior cerebral arteries (A1) and anterior communicating artery (AcomA). ASL perfusion features, type of CoW, and clinical characteristics were analyzed between CH group and non-CH group to identify CH risk factors.
Results:
Higher CoV (p = 0.005) of CBF, lower whole brain perfusion volume ratio (p = 0.012), missing any of A1 or AcomA in CoW (p = 0.002 for postoperative MRA and p = 0.004 for preoperative MRA), and large artery stroke history (p = 0.028) were significantly associated with higher risk of CH. Two cases with cerebral hyperperfusion syndrome (CHS) were also discussed, and their perfusion and angiographic features were shown.
Conclusions:
Single-PLD ASL and MRA might be useful and non-invasive imaging tools to identify patients with higher risk of CH after carotid revascularization.
Key Points:
• Cerebral hyperperfusion is a critical complication after carotid endarterectomy or carotid artery stenting. • ASL and MRA can be used to identify patients at higher risk of cerebral hyperperfusion • Pattern of circle of Willis, ASL perfusion features, and whole brain perfusion volume ratio are potential predicting markers for hyperperfusion after carotid revascularization.
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