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(Stroke. 2009;40:991.)
© 2009 American Heart Association, Inc.

Research Letters

The Utility of Quantitative Magnetic Resonance Angiography in the Assessment of Intracranial In-Stent Stenosis

Shyam Prabhakaran, MD, MS; Lakshmi Warrior, MD; Kalani R. Wells, RN; Miral D. Jhaveri, MD; Michael Chen, MD Demetrius K. Lopes, MD

From Department of Neurological Sciences (S.P., L.W., M.C.), Neurosurgery (K.R.W., D.K.L.), and Radiology (M.D.J.), Rush University Medical Center, Chicago, Ill.

Correspondence to Shyam Prabhakaran, MD, MS, Rush University Medical Center, 1725 W. Harrison Street, Suite 1121 Chicago, IL 60612. E-mail shyam_prabhakaran{at}rush.edu

Background and Purpose— Noninvasive screening for intracranial in-stent stenosis is often limited by artifact because of the stent or associated coils. We aimed to determine the utility of quantitative MRA (QMRA) as a screening tool for detecting intracranial in-stent stenosis.

Methods— We reviewed 14 patients who had intracranial stent placement with follow-up QMRA and conventional angiography at our institution. Socio-demographic, medical, clinical, and imaging data were abstracted from medical charts. A blinded interventional neurologist reviewed all angiograms for presence of >50% in-stent stenosis. We tested QMRA (mL/min) at varying thresholds as a predictor of angiographic results.

Results— Among 14 patients (mean age, 62 years; 12 female, 2 male), 13 patients had Neuroform stents placed for wide-neck cerebral aneurysms and 1 patient had a Wingspan stent placement for atherosclerotic stenosis. Lesions were located in the intracranial internal carotid artery in 57.2% (n=8), the middle cerebral artery in 14.3% (n=2), and vertebrobasilar arteries in 28.6% (n=4). On follow-up angiography, 2 patients (14.3%) had >50% in-stent stenosis on angiography. Time-of-flight MRA was nondiagnostic in each case because of artifact from the stent or coils. A >20% reduction in vessel-specific blood flow by QMRA was associated with presence of >50% in-stent stenosis on angiography (P=0.033). As a screening tool to predict >50% angiographic in-stent stenosis, the sensitivity, specificity, positive predictive value, and negative predictive value of QMRA were 100%, 92%, 67%, and 100%, respectively.

Conclusion— We found that QMRA is a promising screening tool to detect intracranial in-stent stenosis. Future prospective studies should focus on whether QMRA has a role in the detection of radiographic restenosis and prediction of clinical events.

Key Words: blood flow • NOVA • screening • sensitivity

Related Article:

Quantitative Magnetic Resonance Angiography: A Promising Tool in the Assessment of Intracranial In-Stent Stenosis?

Andrew Clifton
Stroke 2009 40: 676. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

				A. Clifton Quantitative Magnetic Resonance Angiography: A Promising Tool in the Assessment of Intracranial In-Stent Stenosis? Stroke, March 1, 2009; 40(3): 676 - 676. [Full Text] [PDF]