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May 14, 2019

ESOC-2019

DYNAMICS OF ARTERIAL SPIN LABELING PERFUSION MRI AND COGNITIVE PERFORMANCE AFTER REVASCULARIZATION OF CAROTID ARTERY STENOSIS

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Abstract

Several studies have suggested a correlation between impairment of cognitive function and asymptomatic carotid artery stenosis without ischemic cerebral brain lesions. Hypoperfusion has been discussed as a possible underlying pathophysiological cause. It remains unclear whether hypoperfusion alone without evidence of infarction is sufficient to cause cognitive decline. In this study, we evaluated cognitive performance and cerebral perfusion changes in patients with asymptomatic carotid artery stenosis by arterial spin labeling (ASL) perfusion MRI before and after revascularization therapy. Methods: 17 asymptomatic patients with unilateral high-grade (≥70%) carotid artery stenosis without evidence of structural brain lesions underwent ASL perfusion MRI and cognitive testing (MMSE, DemTect, Clock-Drawing Test, Trail-Making Test, Stroop Test) before and 6-8 weeks after revascularization therapy by endarterectomy or stenting. Multiparametric perfusion maps (cerebral blood flow (ASL-CBF), bolus arrival time (ASL-BAT)) were calculated and analyzed by vascular territory. Relative perfusion values were calculated. Results: A significant impact of revascularization therapy was shown through multivariate analysis on all perfusion measures analyzed. MCA borderzones were identified as territories showing significant hypoperfuion at baseline post-hoc testing in both ASL-CBF and ASL-BAT. All perfusion alterations normalized after revascularization. No significant correlation of cognitive test results with perfusion parameters was observed. Cognitive Performance showed no significant change after revascularization. Conclusion: Our study was able to show perfusion alterations in asymptomatic patients with high grade carotid artery stenosis in the absence of structural brain lesions, which proved fully reversible after revascularization therapy. In this cohort of asymptomatic patients we did not observe an association of hypoperfusion with cognitive performance.

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© Copyright 2019 Morressier GmbH.
All rights reserved.