Intracerebral steal phenomenon in symptomatic carotid artery disease
Hartkamp, Nolan S.; Hendrikse, Jeroen; de Borst, Gert J.; Kappelle, L. Jaap; Bokkers, Reinoud P.H.
(2019) Journal of neuroradiology, volume 46, issue 3, pp. 173 - 178
(Article)
Abstract
Background and purpose: Intracerebral steal is a paradoxical vasodilatory response that reduces cerebral blood flow (CBF) in hemodynamically compromised brain tissue when blood is rerouted to more healthy areas. The aim of our study was to investigate the presence and extent of steal in patients with steno-occlusive internal carotid artery
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(ICA) disease, and to assess its relation with collateral blood flow through the circle of Willis (CoW). Materials and methods: Thirty-eight patients with symptomatic steno-occlusive ICA disease underwent MRI examination with arterial spin labeling (ASL) perfusion imaging before and after a vasodilatory challenge. Intracerebral steal was defined as a decline in CBF after acetazolamide. Collateral flow via the CoW was assessed with time-of-flight and flow direction MR angiography (MRA) through the CoW was assessed with 2D phase-contrast MRA's. Results: Eight of 38 patients (21%) had steal in the hemisphere ipsilateral to the symptomatic ICA (mean tissue volume with steal, 6.9 ± 4.1 mL; mean CVR, −11 ± 30%). Cerebrovascular reactivity (CVR) was lower in the middle cerebral artery flow territory of the affected hemisphere in patients with steal compared those without (P = 0.002). Collateral blood flow was impaired in 4 of the 8 patients with steal. These patients had a larger area of steal (P = 0.002). Conclusions: Intracerebral steal occurs in patients with obstructive ICA disease and can be assesses at brain tissue level with ASL perfusion MRI. Its presence is related to more severely declined CVR in the surrounding brain tissue area and the volume is associated with impaired primary collateral blood flow through the CoW.
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Keywords: Arterial spin labeling, Carotid artery disease, Cerebral infarction, Cerebrovascular reactivity, Intracerebral vascular steal, Magnetic resonance Imaging, Perfusion imaging, Prospective Studies, Humans, Middle Aged, Collateral Circulation, Acetazolamide, Magnetic Resonance Angiography, Male, Cerebrovascular Circulation, Spin Labels, Carotid Stenosis/physiopathology, Cerebrovascular Disorders/diagnostic imaging, Magnetic Resonance Imaging, Circle of Willis/physiopathology, Female, Aged, Clinical Neurology, Radiological and Ultrasound Technology, Radiology Nuclear Medicine and imaging, Journal Article
ISSN: 0150-9861
Publisher: Elsevier Masson
Note: Funding Information: Dr. J. Hendrikse receives support from the European Research Council (ERC-2014-STG-637024). Funding Information: Dr. R.P.H. Bokkers receives support from the Dutch Heart Foundation (Grant 2013T047). Publisher Copyright: © 2018 Elsevier Masson SAS
(Peer reviewed)