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Title: Cerebrospinal Fluid Enhancement on Fluid Attenuated Inversion Recovery Images After Carotid Artery Stenting with Neuroprotective Balloon Occlusions: Hemodynamic Instability and Blood-Brain Barrier Disruption

Purpose: A rare complication of carotid artery stenting (CAS), prolonged reversible neurological symptoms with delayed cerebrospinal fluid (CSF) space enhancement on fluid attenuated inversion recovery (FLAIR) images, is associated with blood-brain barrier (BBB) disruption. We prospectively identified patients who showed CSF space enhancement on FLAIR images. Methods: Nineteen patients-5 acute-phase and 14 scheduled-underwent 21 CAS procedures. Balloon catheters were navigated across stenoses, angioplasty was performed using a neuroprotective balloon, and stents were placed with after dilation under distal balloon protection. CSF space hyperintensity or obscuration on FLAIR after versus before CAS indicated CSF space enhancement. Correlations with clinical factors were examined. Results: CSF space was enhanced on FLAIR in 12 (57.1%) cases. Postprocedural CSF space enhancement was significantly related to age, stenosis rate, acute-stage procedure, and total occlusion time. All acute-stage CAS patients showed delayed enhancement. Only age was associated with delayed CSF space enhancement in scheduled CAS patients. Conclusions: Ischemic intolerance for severe carotid artery stenosis and temporary neuroprotective balloon occlusion, causing reperfusion injury, seem to be the main factors that underlie BBB disruption with delayed CSF space enhancement shortly after CAS, rather than sudden poststenting hemodynamic change. Our results suggest that factors related to hemodynamic instability or ischemicmore » intolerance seem to be associated with post-CAS BBB vulnerability. Patients at risk for hemodynamic instability or with ischemic intolerance, which decrease BBB integrity, require careful management to prevent intracranial hemorrhagic and other post-CAS complications.« less
Authors:
;  [1] ;  [2] ;  [1] ;  [3]
  1. Mazda Hospital, Department of Neurosurgery (Japan)
  2. Shimane Prefectural Central Hospital, Department of Neurosurgery (Japan)
  3. Hiroshima University Graduate School of Biomedical Sciences, Department of Neurosurgery (Japan)
Publication Date:
OSTI Identifier:
21608585
Resource Type:
Journal Article
Resource Relation:
Journal Name: Cardiovascular and Interventional Radiology; Journal Volume: 34; Journal Issue: 5; Other Information: DOI: 10.1007/s00270-010-0035-4; Copyright (c) 2011 Springer Science+Business Media, LLC and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE); Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; BLOOD-BRAIN BARRIER; CALCIUM SULFIDES; CAROTID ARTERIES; CEREBROSPINAL FLUID; CESIUM FLUORIDES; FLUIDS; HAZARDS; IMAGES; INJURIES; INSTABILITY; PATIENTS; SAFETY; SYMPTOMS ALKALI METAL COMPOUNDS; ALKALINE EARTH METAL COMPOUNDS; ARTERIES; BIOLOGICAL MATERIALS; BLOOD VESSELS; BODY; BODY FLUIDS; CALCIUM COMPOUNDS; CARDIOVASCULAR SYSTEM; CESIUM COMPOUNDS; CESIUM HALIDES; CHALCOGENIDES; DISEASES; FLUORIDES; FLUORINE COMPOUNDS; HALIDES; HALOGEN COMPOUNDS; MATERIALS; ORGANS; SULFIDES; SULFUR COMPOUNDS