Annet Waaijer MD, Presenter: Nothing to Disclose

Irene Van Der Schaaf, Abstract Co-Author: Nothing to Disclose

Evert-Jan Vonken MD, PhD, Abstract Co-Author: Nothing to Disclose

Marcel Quist PhD, Abstract Co-Author: Nothing to Disclose

Birgitta Katinka Velthuis MD, Abstract Co-Author: Nothing to Disclose

Maarten Simon Van Leeuwen MD, PhD, Abstract Co-Author: Nothing to Disclose

Mathias Prokop MD, Abstract Co-Author: Nothing to Disclose

et al, Abstract Co-Author: Nothing to Disclose

To evaluate the effect of treatment on cerebral perfusion in patients with symptomatic carotid artery stenosis using CT perfusion.

We scanned 32 patients with symptomatic carotid artery stenosis before and after primary stent placement (n=22) or carotid endarterectomy (n=10) on a 16 or 40-slice CT scanner. We performed dynamic CT scanning at the level of the basal ganglia during the injection of 40 ml contrast material. From these data CT perfusion images were calculated according to the deconvolution method. On two slabs we manually drew a ROI in the anterior, middle, posterior and deep flow territories yielding 16 ROIs per patient. For cerebral blood volume (CBV) and cerebral blood flow (CBF), we calculated the ratios of measurements in the ROIs in the asymptomatic to symptomatic hemisphere. After selection of two matching slabs we compared the ratios before and after treatment using a paired t-test. The same was done with the difference in MTT between the two hemispheres.

CBV ratios did not change significantly in after treatment. CBF ratios increased significantly in the middle cortical territory from 0.82 ml/100mg/min to 0.90 ml/100mg/min (p= 0.01), and MTT difference decreased significantly in the middle cortical territory from –1.4s to –0.26s (p<0.005), in the middle deep territory from –0.77s to –0.40s (p<0.05) and in the posterior flow territory from -0.41s to -0.14s (p<0.05).

Treatment for symptomatic carotid artery stenosis leads to a significant increased CBF and decreased MTT in the middle cortical flow territory, indicating where treatment has the strongest positive hemodynamic effect on brain perfusion. The anterior flow territory profits least from treatment and therefore seems to be least dependent on ipsilateral carotid artery flow.

Waaijer, A, Van Der Schaaf, I, Vonken, E, Quist, M, Velthuis, B, Van Leeuwen, M, Prokop, M, et al, , Changes in Cerebral Perfusion before and after Treatment for Symptomatic Carotid Artery Stenosis.  Radiological Society of North America 2005 Scientific Assembly and Annual Meeting, November 27 - December 2, 2005 ,Chicago IL. http://archive.rsna.org/2005/4407223.html