J Cerebrovasc Endovasc Neurosurg.  2021 Jun;23(2):136-144. 10.7461/jcen.2021.E2020.10.005.

Use of quantitative magnetic resonance angiography in patients with symptomatic intracranial arterial stenosis who undergo stenting: Presentation of three cases

• Serulle Y
• Khatri D
• Sy H
• Yerneni S
• Langer D
• Ortiz R

• KMID: 2517027
• DOI: http://doi.org/10.7461/jcen.2021.E2020.10.005

Abstract

Intracranial atherosclerotic disease (ICAD) is an important cause of ischemic stroke. The etiology of stroke in patients with ICAD could be due to several mechanisms including hypoperfusion, artery-to-artery embolism, and plaque extension over small penetrating artery ostia. Management of symptomatic ICAD includes medical and endovascular management. Quantitative magnetic resonance angiography (MRA) is a technique that allows for non-invasive measurement of large vessel blood flow in the head and neck. Here, we describe procedural and clinical outcomes on three patients who presented with symptomatic ICAD and were treated with angioplasty and stenting. Quantitative MRA was used pre- and post- procedurally to assess the effects of stenting on the intracranial blood flow. Quantitative measures of intracranial blood flow may serve as an additional triage tool in the evaluation of patients with symptomatic ICAD.

Keyword

Stroke; Ischemia; ICAD; Intervention; Stent; MRA

Figure

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  Fig. 1. (A) MRI NOVA demonstrates decreased flow in left ICA. Frontal (B) and lateral (C) digital subtraction angiography images of the left ICA demonstrate a severe stenosis involving the petrous segment of the ICA (arrowheads). (D) Post procedure MRI NOVA demonstrates improved flow involving the left ICA. Post-balloon angioplasty and stenting frontal (E) and lateral (F) digital subtraction angiography images of the left ICA demonstrate improvement of the previously seen area of stenosis (arrowheads). MRI NOVA, magnetic resonance imaging Noninvasive Optimal Vessel Analysis; ICA, internal carotid artery.

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  Fig. 2. (A) MRI NOVA demonstrates decreased flow in the left MCA both M1 and M2 segments. (B) Frontal digital subtraction angiography image following left internal carotid artery injection demonstrates severe focal stenosis involving the proximal M1 segment of the left MCA (arrowhead). (C) MRI NOVA following angioplasty and stenting of the left MCA demonstrates improvement of flow through the left MCA. (D) Digital subtraction angiography immediately following angioplasty and stenting of the left MCA demonstrates improvement of the stenosis (arrowhead). MRI NOVA, magnetic resonance imaging Noninvasive Optimal Vessel Analysis; MCA, middle cerebral artery.

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  Fig. 3. (A) MRI NOVA demonstrates decreased flow in the left MCA. (B) Digital subtraction angiography demonstrates severe focal occlusion of the proximal M1 segment of the left MCA (arrowhead). (C) MRI NOVA following balloon angioplasty and stenting of the left MCA demonstrates improvement in the flow of the left MCA. (D) Post balloon angioplasty and stenting angiography demonstrates improvement of the focal stenosis (arrowhead). MRI NOVA, magnetic resonance imaging Noninvasive Optimal Vessel Analysis; MCA, middle cerebral artery.

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