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Background: To explore the risk of intracranial hemorrhage (ICH) after internal carotid artery stenting (CAS) in patients with symptomatic severe carotid stenosis by computed tomography perfusion (CTP). Methods: The clinical and imaging data of 87 patients with symptomatic severe carotid stenosis who underwent CTP before CAS were retrospectively analyzed. The absolute values of the cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), and time to peak (TTP) were calculated. The relative values (i.e., the rCBF, rCBV, rMTT, and rTTP), defined as the comparison between ipsilateral and contralateral hemispheres, were also derived. The degree of carotid artery stenosis was divided into 3 grades, and the Willis' circle was classified into 4 types. The relationship between the occurrence of the ICH and CTP parameters, the Willis' circle type, and the clinical baseline data were evaluated. A receiver operating characteristic (ROC) curve analysis was performed to determine the most effective CTP parameter for the prediction of ICH. Results: In total, 8 patients (9.2%) developed ICH after CAS. The results showed that the CBF (P=0.025), MTT (P=0.029), rCBF (P=0.006), rMTT (P=0.004), rTTP (P=0.006), and the degree of carotid artery stenosis (P=0.021) differed significantly between the ICH group and non-ICH group. The ROC curve analysis showed that the CTP parameter with the maximal area under the curve (AUC) for ICH was rMTT (AUC =0.808), which indicated that patients with an rMTT >1.88 were more likely to develop ICH (sensitivity: 62.5%, specificity: 96.2%). The occurrence of ICH after CAS was not related to the type of Willis' circle (P=0.713). Conclusions: CTP can be used to predict ICH after CAS in patients with symptomatic severe carotid stenosis, and patients with a preoperative rMTT >1.88 should be closely monitored for evidence of ICH after CAS.
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OBJECTIVE: Cognitive dysfunction is a serious complication of moyamoya disease (MMD) in adults, and reduced cerebral blood flow (CBF) might be the potential cause. We aimed to explore the correlation between cerebral hemodynamics and cognitive function in adults with MMD by using three-dimensional pseudo-continuous arterial spin labeling (3D-pCASL). METHODS: A total of 24 MMD patients with a history of cerebral infarction, 25 asymptomatic MMD patients, and 25 healthy controls were prospectively enrolled in this study. All participants were performed 3D-pCASL, and cognitive function was evaluated with the Mini-Mental State Examination (MMSE), the Montreal Cognitive Assessment Scale (MoCA), and the Trail Making Test Part A (TMTA). The correlation between cerebral hemodynamics and cognitive function was explored in the region of interest-based analysis. RESULTS: Compared with healthy controls, both CBF and cognition decreased in adult MMD. In the infarction group, the MMSE and MoCA scores correlated with CBF of the right anterior cerebral artery (P = 0.037 and 0.010, respectively) and the left middle cerebral artery (MCA) cortical territories (P = 0.002 and 0.001, respectively), and the TMTA time-consuming has a negative correlation with CBF of the right and left MCA cortical territories (P = 0.044 and 0.010, respectively); in the asymptomatic group, the MMSE and MoCA scores correlated with CBF of the left MCA cortical territory (P = 0.032 and 0.029, respectively). CONCLUSIONS: The 3D-pCASL can find the hypoperfusion area of CBF in adults with MMD, and hypoperfusion in specific brain regions may cause cognitive dysfunction even in asymptomatic patients.