Effective collateral circulation may indicate improved perfusion territory restoration after carotid endarterectomy

Lin, Tianye; Lai, Zhichao; Lv, Yuelei; Qu, Jianxun; Zuo, Zhentao; You, Hui; Wu, Bing; Hou, Bo; Liu, Changwei; Feng, Feng

doi:10.1007/s00330-017-5020-8

Cited by 23 publications

(17 citation statements)

References 27 publications

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“…More and more studies have confirmed that cerebral vascular stenosis first leads to hypoperfusion in the perfusion territory, while increasing cerebral collateral circulation to compensate for impaired cerebral blood flow, and carotid endarterectomy and carotid stent can significantly improve rCBF Fig. 1 The cubic simulation curve between TSS and GBF (a), and between RI-TSS and GBF (b) in the perfusion territory [14][15][16]. However, the effects of these local vascular stenosis on GBF and the relationship between degree of carotid stenosis and GBF have not been reported.…”

Section: Discussionmentioning

confidence: 98%

The role of carotid stenosis ultrasound scale in the prediction of ischemic stroke

Tang

Wang

et al. 2020

Neurol Sci

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Introduction To improve the accuracy of ultrasound techniques for the assessment of carotid stenosis, we designed a novel carotid artery stenosis ultrasound scale (CASUS), and evaluated its accuracy, reliability, and its value in predicting the occurrence of cardiovascular and cerebrovascular diseases in a prospective study. Methods A total of 750 patients with first-time ischemic stroke and hospitalized within 24 h were enrolled in the study. Using color Doppler ultrasound (CDUS), the degree of stenosis and blood flow (BF) in bilateral internal carotid arteries (ICA) and the V1-V3 segment of vertebral arteries (VA) was assessed. Cubic simulation curves for BF and global blood flow (GBF) over the stenosis score (SS), total stenosis score (TSS), and radiological imaging-total stenosis score (RI-TSS) were fitted and compared. The receiver operating characteristic (ROC) curves using TSS, RI-TSS, or GBF to predict various ischemic stroke endpoints were also analyzed and compared. Results There was a linear relationship between SS and BF both ICA and VA (R2 were 0.734 and 0.783, respectively, both P < 0.05). Both TSS and RI-TSS with GBF showed an inverse "S" curve relationship (R2 was 0.839 and 0.843, all P < 0.05). The AUC values of TSS-based and RI-TSS-based predictions of each endpoint were all greater than 0.7 (all P < 0.05), but the differences of the AUC values between TSS, RI-TSS, and GBF were not statistically significant (all P > 0.05). Conclusions The novel CASUS can better reflect the level of cerebral reperfusion in patients with ischemic stroke and can better predict the occurrence of cardiovascular and cerebrovascular diseases. Keywords Brain ischemic. Carotid stenosis. Ultrasound. Neuroimaging. Cerebral blood flow Yi Tang and Ming-yu Wang contributed equally to this work.

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Section: Discussionmentioning

confidence: 98%

The role of carotid stenosis ultrasound scale in the prediction of ischemic stroke

Tang

Wang

et al. 2020

Neurol Sci

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“…CBF is an important parameter that determines the condition of the brain. Increased CBF indicates potential increased brain activity, and a pathological decrease in CBF can immediately cause reversible or irreversible damage to brain tissue 17 . A previous study has reported that DSA may force some physiologically closed shunts to open due to the injection pressure of the contrast agent, resulting in an overestimation of CBF 31 .…”

Section: Discussionmentioning

confidence: 99%

“…31 tASL can avoid this problem since no contrast agent is injected. Lin et al 17 performed tASL examination on patients undergoing CEA surgery and found that the CBF of the affected side and the contralateral side both increased after the operation, allowing a more comprehensive evaluation of the surgical effect. According to the literature 13 and our results, tASL is more reliable for monitoring changes in CBF after surgery than solely relying on the degree of stenosis to assess these changes.…”

Section: Figurementioning

confidence: 99%

“…tASL has been used to evaluate carotid endarterectomy (CEA) and moyamoya revascularization 16 . Lin et al 17 studied the changes in tASL perfusion area after CEA and found that patients whose perfusion area returned to normal had good collateral circulation. Yuan et al 18 used tASL to evaluate the vascular recanalization area obtained by superficial temporal artery‐middle cerebral artery bypass and reported that tASL can directly show the revascularization and postoperative changes in the main cerebral artery perfusion area.…”

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confidence: 99%

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Can 3D Pseudo‐Continuous Territorial Arterial Spin Labeling Effectively Diagnose Patients With Recanalization of Unilateral Middle Cerebral Artery Stenosis?

Wang

Dou²,

Dong

et al. 2021

Magnetic Resonance Imaging

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Background: Unilateral middle cerebral artery (MCA) stenosis, as an independent risk factor for stroke, requires an intervention operation for vessel recanalization. Accurate perfusion measurement is thus essential after the operation. Purpose: To explore the feasibility of three-dimensional (3D) pseudo-continuous territorial arterial-spin-labeling (tASL) in evaluating MCA recanalization. Study Type: Prospective and longitudinal. Subjects: Forty-seven patients with unilateral MCA stenosis or occlusion. Field Strength/Sequence: A 3.0 T, 3D time-of-flight fast-field-echo magnetic resonance (MR) angiography sequence, spinecho echo-planar diffusion-weighted imaging sequence, 3D fast-spin-echo pseudo-continuous ASL (pcASL) and tASL sequences. Assessment: All patients underwent MR examination before and after MCA recanalization and scored using the National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) at admission and discharge. An mRS score <2 was defined as a good prognosis. 3D-pcASL and tASL cerebral blood flow (CBF) maps were obtained, and the corresponding Alberta Stroke Program Early CT Score (ASPECTS)-based scores were evaluated. Statistical Tests: The Kolmogorov-Smirnov test, intra-class correlation coefficient, paired t-test, receiver operating characteristic (ROC) curve, and multivariable logistic regression analysis. Results: After recanalization, tASL derived absolute CBFs between the affected and contralateral sides were significantly higher than before the operation (mean: 34.3 AE 8.5 mL/100 g/min vs. 40.6 AE 9.2 mL/100 g/min, 42.6 AE 9.8 mL/100 g/min vs. 43.5 AE 9.9 mL/100 g/min, both P < 0.05). In ROC analysis, tASL provided good prognosis (area under ROC curve [AUC] = 0.829; 95% CI: 0.651-1.000, P < 0.05), while pcASL had lower prognostic value (AUC = 0.760; 95% CI: 0.574-0.946, P < 0.05). The NIHSS score before recanalization, pcASL, and tASL-based ASPECTS scores were significantly associated with good clinical outcome (P < 0.05). Multivariable analysis revealed that ASPECTS-based scores of pcASL and tASL before and after surgery were independent predictors of good clinical outcome (all P < 0.05). Data Conclusion: tASL can determine hypoperfusion in the responsible vascular perfusion area and predict clinical outcome. Evidence Level: 4 Technical Efficacy: Stage 2

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“…While the feasibility of SS‐pCASL has been shown previously in a number of clinical applications, SNR still remains a challenge . Pseudo‐continuous labeling is well known to be a low SNR technique.…”

Section: Introductionmentioning

confidence: 99%

Practical considerations for territorial perfusion mapping in the cerebral circulation using super‐selective pseudo‐continuous arterial spin labeling

Schollenberger

Figueroa

Nielsen

et al. 2019

Magnetic Resonance in Med

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Purpose: This paper discusses several challenges faced by super-selective pseudo-continuous arterial spin labeling, which is used to quantify territorial perfusion in the cerebral circulation. The effects of off-resonance, pulsatility, vessel movement, and label rotation scheme are investigated, and methods to maximize labeling efficiency and overall image quality are evaluated. A strategy to calculate the territorial perfusion fractions of individual vessels is proposed. Methods: The effects of off-resonance, label rotation scheme, and vessel movement on labeling efficiency were simulated. Two off-resonance compensation strategies (multiphase prescan, field map), cardiac triggering, and vessel movement were studied in vivo in a group of 10 subjects. Subsequently, a territorial perfusion fraction map was acquired in 2 subjects based on the mean vessel labeling efficiency. Results: Multiphase calibration provided the highest labeling efficiency (P = .002) followed by the field map compensation (P = .037) compared with the uncompensated acquisition. Cardiac triggering resulted in a qualitative improvement of the image and an increase in signal contrast between the perfusion territory and the surrounding tissue (P = .010) but failed to show a significant change in temporal and spatial SNR. The constant clockwise label rotation scheme yielded the highest labeling efficiency. Significant vessel movement (>2 mm according to simulations) was observed in 50% of subjects. The measured territorial perfusion fractions showed good agreement with anatomical data. Conclusion: Optimized labeling efficiency resulted in increased image quality and accuracy of territorial perfusion fraction maps. Labeling efficiency depends critically on off-resonance calibration, cardiac triggering, optimal label rotation scheme, and vessel location tracking. K E Y W O R D Sarterial spin labeling, cardiac triggering, labeling efficiency, off-resonance, super-selective, territorial perfusion | 493 SCHOLLENBERGER Et aL.

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Effective collateral circulation may indicate improved perfusion territory restoration after carotid endarterectomy

Cited by 23 publications

References 27 publications

The role of carotid stenosis ultrasound scale in the prediction of ischemic stroke

The role of carotid stenosis ultrasound scale in the prediction of ischemic stroke

Can 3D Pseudo‐Continuous Territorial Arterial Spin Labeling Effectively Diagnose Patients With Recanalization of Unilateral Middle Cerebral Artery Stenosis?

Practical considerations for territorial perfusion mapping in the cerebral circulation using super‐selective pseudo‐continuous arterial spin labeling

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