Perioperative Changes in Cerebral Perfusion Territories Assessed by Arterial Spin Labeling Magnetic Resonance Imaging Are Associated with Postoperative Increases in Cerebral Blood Flow in Patients with Carotid Stenosis

Objective: The magnetic resonance imaging technique known as territorial arterial spin labeling (TASL) allows for noninvasive visualization of perfusion territories. The objective of this study was to use TASL to assess the relationship between perioperative changes in the perfusion territories of the internal carotid artery (ICA) and cerebral blood flow (CBF) after carotid revascularization.

Methods: In 32 patients, ICA perfusion volume (PV) and CBF were measured before and after carotid endarterectomy/carotid artery stenting using TASL and single-photon emission computed tomography, respectively. ICA flow was measured during carotid endarterectomy before and after reconstruction, using an electromagnetic flowmeter. Eleven healthy volunteers, as the normal control group, underwent TASL evaluation.

Results: We classified patients into 2 groups: the normal PV group (ICA PV ≥ mean-2 standard deviation of healthy volunteers; n = 13) and the reduced PV group (ICA PV < mean-2 standard deviation; n = 19). The postoperative increase in the ICA PV and CBF were significantly greater in the reduced PV group than in the normal group (90.4% ± 131.8% vs. 10.5 ± 9.8%, P = 0.017, 32.0 ± 25.7% vs. 10.5% ± 10.7%, P = 0.0032, respectively). ICA flow increased significantly after reconstruction in both the normal PV group (115.1 ± 48.1 mL/minute to 159.1 ± 53 mL/minute; P = 0.016) and reduced PV group (57.8 ± 38.3 mL/minute to 182.3 ± 52.6 mL/minute; P < 0.0001). However, in some patients in the reduced PV group, the PV increased only slightly, whereas the ICA flow markedly increased, which resulted in a large CBF increase, such as hyperperfusion.

Conclusions: The TASL study suggested that an imbalance between increases in the PV and ICA flow could play an important role in the pathophysiology underlying postoperative abnormal increases in CBF.