Armando Tartaro MD, PRESENTER: Nothing to Disclose

Abstract: HTML Purpose: Cerebral hyperperfusion syndrome (CHS) is a serious complication of carotid endarterectomy (CEA) caused by loss of cerebral autoregolation, resulting from chronic cerebral ischemia. The aim of this study was to evaluate latent hypoxic damage to the blood brain barrier (BBB), as a consequence of chronic cerebral ischemia, by means of contrast-enhanced brain MRI combined with epiaortic and intracranial MRA. Methods and Materials: 589 patients (mean age 69.8 years), considered candidates for CEA, underwent in a single session brain MRI before and after the iv administration of 0.1 mmol/kg gadobenate dimeglumine (Gd-BOBTA); MultiHance) and MRA of epiaortic and intracranial arteries. None of the patients had a history of recent stroke. BBB breakdown was assessed as areas of contrast enhancement on T1 weighted images with or without signal alteration on FLAIR images. Two radiologists in joint sessions reviewed all the exams. Patients with BBB breakdown underwent a second brain MRI scan, before and after iv administration of contrast medium (CM) after one and two months if necessary. Results: Twenty-seven areas of contrast enhancement were found in 21 (3.5%) patients; all but two of these areas were hyperintense on FLAIR images. Combined severe stenoses of the internal carotid (ICA) and intracranial arteries were found in 15/21 patients (71.4%) whereas isolated stenosis of the ICA or intracranial arteries was found in 4/21 (19.0%) and 2/21 (9.5%) patients, respectively. All patients showed a complete recovery of BBB breakdown at the second brain MRI scan. Conclusion: Combined contrast-enhanced brain MRI and MRA, performed in the workup before CEA, can reveal BBB breakdown in patients with chronic cerebral ischemia and arteriosclerosis of intracranial and epiaortic vessels.       Questions about this event email: a.tartaro@radiol.unich.it

Tartaro MD, A, Contrast-enhanced MRI Combined with Epiaortic and Intracranial MRA for the Assessment of Latent Brain Barrier Damage in Candidates for Carotid Endarterectomy.  Radiological Society of North America 2003 Scientific Assembly and Annual Meeting, November 30 - December 5, 2003 ,Chicago IL. http://archive.rsna.org/2003/3107037.html