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

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. We reviewed 14 patients who had intracranial...

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Bibliographic Details
Published in:Stroke (1970) 2009-03, Vol.40 (3), p.991-993
Main Authors: PRABHAKARAN, Shyam, WARRIOR, Lakshmi, WELLS, Kalani R, JHAVERI, Miral D, CHEN, Michael, LOPES, Demetrius K
Format: Article
Language:English
Subjects:
Aged
Atherosclerosis - pathology
Atherosclerosis - surgery
Biological and medical sciences
Cerebrovascular Circulation
Cerebrovascular Disorders - diagnosis
Constriction, Pathologic - pathology
Constriction, Pathologic - surgery
Female
Graft Occlusion, Vascular - diagnosis
Humans
Intracranial Aneurysm - surgery
Investigative techniques, diagnostic techniques (general aspects)
Magnetic Resonance Angiography - methods
Male
Medical sciences
Middle Aged
Middle Cerebral Artery - pathology
Nervous system
Neurology
Predictive Value of Tests
Radiodiagnosis. Nmr imagery. Nmr spectrometry
Retrospective Studies
Stents
Vascular diseases and vascular malformations of the nervous system
Vertebrobasilar Insufficiency - surgery
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Summary: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. 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. 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. 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.
ISSN:0039-2499
1524-4628
DOI:10.1161/STROKEAHA.108.522391