Tianye Lin1, Zhichao Lai2, Yuelei Lv1, Jianxun Qu3, Zhentao Zuo4, Hui You1, Bing Wu3, Bo Hou1, Changwei Liu5, Feng Feng6. 1. Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan, Beijing, China. 2. Department of Vascular Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan, Beijing, China. 3. GE Healthcare, MR Research China, Beijing, China. 4. Institute of Biophysics, Chinese Academy of Sciences, Beijing, China. 5. Department of Vascular Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan, Beijing, China. liucw@vip.sina.com. 6. Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, No.1 Shuaifuyuan, Beijing, China. cjr.fengfeng@vip.163.com.
Abstract
OBJECTIVES: To investigate the relationship between the level of collateral circulation and perfusion territory normalisation after carotid endarterectomy (CEA). METHODS: This study enrolled 22 patients with severe carotid stenosis that underwent CEA and 54 volunteers without significant carotid stenosis. All patients were scanned with ASL and t-ASL within 1 month before and 1 week after CEA. Collateral circulation was assessed on preoperative ASL images based on the presence of ATA. The postoperative flow territories were considered as back to normal if they conformed to the perfusion territory map in a healthy population. Neuropsychological tests were performed on patients before and within 7 days after surgery. RESULTS: ATA-based collateral score assessed on preoperative ASL was significantly higher in the flow territory normalisation group (n=11, 50 %) after CEA (P < 0.0001). The MMSE (mean change=1.36±0.96) and MOCA (mean change=1.18±0.95) test scores showed a significant postoperative (7 days after CEA) improvement in the flow territory normalisation group [>mean differences+2SD among control (MMSE=1.35, MOCA=1.02)]. CONCLUSIONS: This study demonstrated that effective collateral flow in carotid stenosis patients was associated with normalisation of t-ASL perfusion territory after CEA. The perfusion territory normalisation group tends to have more cognitive improvement after CEA. KEY POINTS: • Evaluation of collaterals before CEA is helpful for avoiding ischaemia during clamping. • There was good agreement on ATA-based ASL collateral grading. • Perfusion territories in carotid stenosis patients are altered. • Patients have better collateral circulation with perfusion territory back to normal. • MMSE and MOCA test scores improved more in the territory normalisation group.
OBJECTIVES: To investigate the relationship between the level of collateral circulation and perfusion territory normalisation after carotid endarterectomy (CEA). METHODS: This study enrolled 22 patients with severe carotid stenosis that underwent CEA and 54 volunteers without significant carotid stenosis. All patients were scanned with ASL and t-ASL within 1 month before and 1 week after CEA. Collateral circulation was assessed on preoperative ASL images based on the presence of ATA. The postoperative flow territories were considered as back to normal if they conformed to the perfusion territory map in a healthy population. Neuropsychological tests were performed on patients before and within 7 days after surgery. RESULTS: ATA-based collateral score assessed on preoperative ASL was significantly higher in the flow territory normalisation group (n=11, 50 %) after CEA (P < 0.0001). The MMSE (mean change=1.36±0.96) and MOCA (mean change=1.18±0.95) test scores showed a significant postoperative (7 days after CEA) improvement in the flow territory normalisation group [>mean differences+2SD among control (MMSE=1.35, MOCA=1.02)]. CONCLUSIONS: This study demonstrated that effective collateral flow in carotid stenosispatients was associated with normalisation of t-ASL perfusion territory after CEA. The perfusion territory normalisation group tends to have more cognitive improvement after CEA. KEY POINTS: • Evaluation of collaterals before CEA is helpful for avoiding ischaemia during clamping. • There was good agreement on ATA-based ASL collateral grading. • Perfusion territories in carotid stenosispatients are altered. • Patients have better collateral circulation with perfusion territory back to normal. • MMSE and MOCA test scores improved more in the territory normalisation group.
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