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AJNR - American Journal of Neuroradiology

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Carotid Stent Delivery in an XMR Suite: Immediate Assessment of the Physiologic Impact of Extracranial Revascularization

Alastair J. Martin^a, David A. Saloner^a, Timothy P. L. Roberts^a, Heidi Roberts^a, Oliver M. Weber^a, William Dillon^a, Sean Cullen^a, Van Halbach^a,b,c, Christopher F. Dowd^a,b,c and Randall T. Higashida^a,b,c

^a Department of Radiology, University of California—San Francisco, San Francisco, CA
^b Department of Neurological Surgery, University of California—San Francisco, San Francisco, CA
^c Department of Neurology, University of California—San Francisco, San Francisco, CA
^d Philips Medical Systems, Best, the Netherlands

View larger version (119K): [in a new window]   FIG 1. An XMR suite coupling an MR imaging scanner (background) with a catheterization lab (foreground). The patient lies on a floating tabletop that moves between the two systems on a continuous track. Magnetic isocenter and the conventional radiographic imaging position are separated by 6 m, and patients can be transferred between these two stations in less than 1 minute.

View larger version (60K): [in a new window]   FIG 2. A very high-grade stenosis of the ICA depicted via 3DRA (A). Tight stenoses such as this could not be directly depicted with CE-MRA, although the presence of downstream contrast and measurable flow provide evidence of residual patency. B, Magnitude (top) and phase (bottom) MR images demonstrating the ICA (arrows) just distal to the stenosis, where the phase image reveals small, but nonzero, flow.

View larger version (104K): [in a new window]   FIG 3. Measurement of flow changes within neck arteries is demonstrated. A, Section positioning (line) was performed on CE-MRA data such that the section was approximately perpendicular to the vessels and just distal or proximal to the stenosis (arrow). Qflow measurements were then performed at this site immediately before (B) and following (C) stent placement. Shown are the magnitude (left) and phase (right) images demonstrating the reproducibility of the scan plane and the increase in flow in the stented artery (arrows).

View larger version (118K): [in a new window]   FIG 4. rCBV (left column) and TTP (right column) images obtained immediately before (top row) and following (bottom row) placement of a stent in the patient’s left carotid artery. Initially the ipsilateral hemisphere exhibited delayed arrival times, but this reversed following treatment. The patient’s contralateral ICA was also somewhat stenotic, and this may be responsible for the inversion following stent placement.

View larger version (76K): [in a new window]   FIG 5. Turbo-FLAIR imaging performed before treatment (left) and immediately following (right) placement of a stent in the left carotid artery. Following treatment, substantial enhancement of the CSF is evident but spatially limited to the ipsilateral hemisphere. The pretreatment turbo-FLAIR was performed shortly after the administration of contrast but did not exhibit CSF enhancement.