(Stroke. 2000;31:848.)
© 2000 American Heart Association, Inc.
Original Contributions |
Unilateral Leptomeningeal Enhancement After Carotid Stent Insertion Detected by Magnetic Resonance Imaging
From the Section of Academic Radiology, University of Sheffield (I.D.W., P.D.G., N.H.); Sheffield Vascular Institute, Northern General Hospital (T.J.C., P.A.G.); and Department of Neurology, Royal Hallamshire Hospital (G.S.V.), Sheffield, England.
Correspondence to Dr I.D. Wilkinson, Academic Radiology, C Floor, Royal Hallamshire Hospital, Glossop Road, Sheffield, England S10 2JF. E-mail i.d.wilkinson{at}sheffield.ac.uk
Background and Purpose—Percutaneous transluminal angioplasty combined with vascular stenting is currently being assessed in the treatment of patients with symptomatic, severe carotid stenosis. The immediate cerebral hemodynamic effects resulting from stenting are not fully understood. This article describes a novel finding: abnormal leptomeningeal enhancement after stenting shown by MRI.
Methods—Fourteen patients with symptomatic severe carotid bifurcation stenosis underwent MRI within 4 hours before and within 3 hours after attempted carotid stenting. Twelve patients were successfully stented. Part of the MR investigation consisted of the acquisition of T1-weighted images before and after administration of the contrast agent Gd-DTPA, both before and after the procedure.
Results—All 12 patients who underwent successful stenting did not have abnormal enhancement of the leptomeninges before stenting but developed unilateral enhancement following intervention but before the second injection of contrast agent. No contrast enhancement was detected in the 2 patients who had the angiographic procedure but were not stented.
Conclusions—These findings suggest that abnormal changes to the leptomeningeal vasculature occur during carotid stenting which are not associated with sudden development of neurological symptoms. The anatomic distribution of the enhancement suggests that it is a consequence of the sudden change in brain hemodynamics secondary to the improvement in carotid flow after stenting.
Key Words: angioplasty • blood-brain barrier • carotid stenosis • magnetic resonance imaging • stenting
This article has been cited by other articles:
 |
|
 |
|
  J.M. Morris and G.M. Miller Increased Signal in the Subarachnoid Space on Fluid-Attenuated Inversion Recovery Imaging Associated with the Clearance Dynamics of Gadolinium Chelate: A Potential Diagnostic Pitfall AJNR Am. J. Neuroradiol., November 1, 2007; 28(10): 1964 - 1967. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Ozturk, I. Saatci, A.G. Pamuk, C. Erdogan, I. Akmangit, S. Geyik, and H.S. Cekirge Focal Increased Cortical Density in Immediate Postembolization CT Scans of Patients with Intracranial Aneurysms. AJNR Am. J. Neuroradiol., October 1, 2006; 27(9): 1866 - 1875. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. D. Wilkinson, P. D. Griffiths, N. Hoggard, T. J. Cleveland, P. A. Gaines, S. Macdonald, F. McKevitt, and G. S. Venables Short-Term Changes in Cerebral Microhemodynamics after Carotid Stenting AJNR Am. J. Neuroradiol., September 1, 2003; 24(8): 1501 - 1507. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. D. Griffiths, S. C. Coley, C. A. J. Romanowski, T. Hodgson, and I. D. Wilkinson Contrast-Enhanced Fluid-Attenuated Inversion Recovery Imaging for Leptomeningeal Disease in Children AJNR Am. J. Neuroradiol., April 1, 2003; 24(4): 719 - 723. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C.-J. Lu, Y. Sun, and K.-M. Huang Leptomeningeal Enhancement After Carotid Stenting Stroke, September 1, 2000; 31 (9): 2266 - 2278. [Full Text] [PDF]
|
|
|
|
|
|
T. Bretschneider, M. Strotzer, I. D. Wilkinson, P. D. Griffiths, N. Hoggard, T. J. Cleveland, P. A. Gaines, and G. S. Venables Leptomeningeal Enhancement and Extravasation of Contrast Medium into the CSF Space? Response to the Preceding 2 Letters Stroke, September 1, 2000; 31 (9): 2266 - 2278. [Full Text] [PDF]
|
|