Normalization of cerebral vasoreactivity using BOLD MRI after intravascular stenting.
BACKGROUND AND PURPOSE
Intravascular angioplasty and stenting of intracranial arterial stenosis provided controversial results. Besides the expertise of the practitioners, the selection of the patients remains challenging. BOLD MRI of the cerebral vasoreactivity (BOLD MRI CVR) to hypercapnia provides reproducible maps of the entire brain of the vascular reserve, and could be helpful to assess the best therapeutic strategy.


CASE HISTORY
We report the case of a 63-year-old woman referred for a severe stenosis of the proximal portion of the left middle cerebral artery, revealed by a lenticulostriate and precentral infarction. Despite an aggressive medical treatment during 5 months, the occurrence of iterative transient ischemic attacks motivated intravascular stenting. Functional MRI of the vasoreactivity to hypercapnia using both Blood Oxygen Level Dependent (BOLD) and arterial spin labeling sequences showed normal basal perfusion and impaired vasoreactivity in the left middle cerebral artery territory. Three months after stenting, the BOLD MRI CVR showed vasoreactivity normalization. Since, the patient remains free of ischemic disorders one year after stenting.


CONCLUSION
BOLD MRI of the CVR to hypercapnia may be helpful to optimize the treatment of patients with intracranial arterial stenosis, and could be performed in future therapeutic trials.
['Attyé|Arnaud|A|', 'Villien|Marjorie|M|', 'Tahon|Florence|F|', 'Warnking|Jan|J|', 'Detante|Olivier|O|', 'Krainik|Alexandre|A|']
D001921:Brain D020520:Brain Infarction D001931:Brain Mapping D002533:Cerebral Angiography D002539:Cerebral Arterial Diseases D002560:Cerebrovascular Circulation D003251:Constriction, Pathologic D005260:Female D006801:Humans D006935:Hypercapnia D008279:Magnetic Resonance Imaging D008875:Middle Aged D020768:Middle Cerebral Artery D010100:Oxygen D015607:Stents D016896:Treatment Outcome
cerebral vasoreactivity BOLD MRI intravascular stenting hypercapnia intracranial stenosis transient ischaemic attack