Cerebral haemodynamic disturbances in patients with moderate carotid artery stenosis.
ABSTRACT Dynamic MR perfusion imaging can detect cerebral perfusion deficits resulting from severe internal carotid artery (ICA) stenosis. It is unknown, however, whether moderate ICA stenosis (50-69%) also causes haemodynamic disturbance. We investigated whether cerebral perfusion deficits were detectable in patients with moderate ICA stenosis.
Eighteen patients underwent T2* weighted cerebral MR perfusion imaging with a gadolinium based contrast agent. Differences in mean time to peak (mTTP) and relative cerebral blood volume (rCBV) between cerebral hemispheres were calculated for middle cerebral artery territory regions by a reader blinded to the angiographic and clinical findings.
There were significant differences in mTTP between cerebral hemispheres in 15 patients with a mean inter-hemispheric delay in mTTP of 0.49 s (95% confidence intervals, 0.25 and 0.72 s) which was statistically significant ( p <0.001). In 1 patient with bilateral moderate stenosis there was no difference in mTTP.
Moderate ICA stenosis results in significant ipsilateral cerebral perfusion delays detectable by dynamic susceptibility MRI. Follow-up studies might reveal whether these delays improve following carotid endarterectomy.
- SourceAvailable from: Arkadiusz Siennicki-Lantz[Show abstract] [Hide abstract]
ABSTRACT: To examine if mild carotid stenosis correlates with silent vascular brain changes, we studied a prospective population-based cohort "Men born in 1914." Data from followups at ages 68 and 81, have been used. Carotid ultrasound was performed at age 81, and cerebral blood flow (CBF) was measured with SPECT at age 82. Out of 123 stroke-free patients, carotid stenosis <50% was observed in 94% in the right and 89% in the left internal carotid arteries (ICAs). In these subjects, Peak Systolic Velocities in ICA correlated negatively with CBF in a majority of several brain areas, especially in mesial temporal area. Results were limited to normotensive until their seventies, who developed late-onset hypertension with a subsequent blood pressure, pulse pressure, and ankle-brachial index growth. Elderly with asymptomatic carotid stenosis <50% and peak systolic velocities in ICA 0.7-1.3 m/s, should be offered an intensified pharmacotherapy to prevent stroke or silent cerebrovascular events.International journal of vascular medicine 01/2012; 2012:579531.
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ABSTRACT: Characterization of the brain's vascular system is of major clinical importance in the assessment of patients with cerebrovascular disease. The aim of this study was to characterize brain hemodynamics using multiparametric methods and to obtain reference values from the healthy brain. A multimodal MRI study was performed in twenty healthy subjects, including dynamic susceptibility contrast (DSC) imaging and blood oxygen level dependence (BOLD) during hypercapnia and carbogen challenges. Brain tissues were defined using unsupervised cluster analysis based on these three methods, and several hemodynamic parameters were calculated for gray matter (GM), white matter (WM), blood vessels & dura (BVD); the three main vascular territories within the GM; and arteries and veins defined within the BVD cluster. The carbogen challenge produced a BOLD signal twice as high as the hypercapnia challenge, in all brain tissues. The three brain tissues differed significantly from each other in their hemodynamic characteristics, supporting the graded vascularity of the tissues, with BVD>GM>WM. Within the GM cluster, a significant delay of ∼1.2 sec of the bolus arrival time was detected within the posterior cerebral artery territory relative to the middle and anterior cerebral arteries territories. No differences were detected between right and left middle cerebral arteries territories for all hemodynamic parameters. Within the BVD cluster, a significant delay of ∼1.9 sec of the bolus arrival time was detected within the veins relative to the arteries. This parameter enabled to differentiate between the various blood vessels, including arteries, veins and choroid plexus. This study provides reference values for several hemodynamic parameters, obtained from healthy brains, and may be clinically important in the assessment of patients with various vascular pathologies.Neuroscience 03/2013; · 3.12 Impact Factor
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ABSTRACT: Late-onset epilepsy (LOE) first occurs after 60 years of age and may be due to occult cerebrovascular disease (CVD) which confers an increased risk of stroke. However, patients with late-onset epilepsy are not currently consistently investigated or treated for cerebrovascular risk factors. We discuss how abnormalities of neurovascular unit function, namely, changes in regional cerebral blood flow and blood brain barrier disruption, may be caused by occult cerebrovascular disease but present clinically as late-onset epilepsy. We describe novel magnetic resonance imaging methods to detect abnormal neurovascular unit function in subjects with LOE and controls. We hypothesise that occult CVD may cause LOE as a result of neurovascular unit dysfunction.Cardiovascular Psychiatry and Neurology 01/2011; 2011:130406.