Perfusion Magnetic Resonance Imaging with Arterial Spin Labeling in the Perioperative Management of Carotid Artery Stenosis

Abstract

Cerebral hyperperfusion syndrome is a rare but devastating complication after carotid endarterectomy (CEA) or carotid artery stenting (CAS). We evaluated whether arterial spin labeling (ASL) can predict cerebral hyperperfusion syndrome after carotid revascularization.
Here we reviewed 10 cases of carotid artery stenosis treated with CEA or CAS. Five cases presented with hyperperfusion phenomenon on single photon emission computed tomography. In four of these five cases, ASL was found to be useful in predicting hyperperfusion phenomenon. There were no cases of intracerebral hemorrhage.
ASL is noninvasive and useful for understanding cerebral perfusion during the perioperative period that requires several minutes on routine MRI.
However, there are some limitations. To avoid misinterpretation of data, it is important that clinicians have a good understanding of the basic principles of ASL.