Abstract
Objective: To investigate the clinical value of CT perfusion (CTP) imaging in vertebral artery stenosis stenting, so as to provide the basis for preoperative and postoperative evaluation. Ninety-seven patients with vertebral artery stenosis were accepted for endovascular stenting between Jan 2016 and Jan 2020. CT angiography, Digital Subtraction Angiography, and CTP were performed pre-operation and post-operation. The cerebral blood volume (CBV), cerebral blood flow (CBF), and mean transmit time (MTT) between the health and affected sides were analyzed statistically, and the imaging results pre- and post-operation were evaluated. The stenosis was relieved by endovascular stents in all 97 patients without serious complications. The abnormal perfusion was observed in 66 patients (68%). The differences in CBF and MTT between the diseased side and healthy side were statistically significant (P < 0.05). Compared with the preoperative imaging, the postoperative CTP was improved in 59 patients (89%). The differences in CBF and MTT between pre-operation and post-operation were statistically significant (P < 0.05). But there was no significant difference in CBV. CTP can sensitively reflect the perfusion of brain, and can also be used for preoperative and postoperative evaluation of vertebral artery stenting. It may be helpful as an adequate indicator of vertebral artery stenosis stent surgery.
Highlights
Stroke is a serious threat to human health, ∼87% of all strokes are ischemic strokes [1], among which posterior circulation (PC) ischemic stroke accounts for about 20%
The indications of stenting for vertebral artery stenosis are usually determined by whether the degree of stenosis is more than 50% which is detected by CT angiography (CTA) or Digital Subtraction Angiography (DSA) examination before operation, and corresponding clinical symptoms such as dizziness, walking unsteadily, or the other symptoms [10,11,12,13]
Several studies suggested that CT perfusion (CTP), mean transit time (MTT), and cerebral blood flow (CBF) can quantitatively and effectively evaluate cerebral hemodynamic abnormalities before cerebral infarction [14]
Summary
Stroke is a serious threat to human health, ∼87% of all strokes are ischemic strokes [1], among which posterior circulation (PC) ischemic stroke accounts for about 20%. Patients with vertebral artery stenosis may only show dizziness, but dizziness can be caused by several diseases. Even if vertebral artery stenosis causes cerebral ischemia, CT and MRI do not show ischemic lesions due to the compensation of CT Perfusion collateral circulation. The indication of vertebral artery stenosis stent surgery has often been determined by clinical symptoms which sometimes may be not obvious and neglected, the degree of imaging stenosis, and lack of objective indicators. CTP may be helpful as an adequate indicator of vertebral artery stenosis stent surgery
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