MRI evidence of reperfusion injury associated with neurological deficits after carotid revascularization procedures

• Published in: European journal of neurology Vol. 16; no. 9; pp. 1066 - 1069
• Main Authors: Cho, A-H., Suh, D-C., Kim, G. E., Kim, J. S., Lee, D. H., Kwon, S. U., Park, S. M., Kang, D-W.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01-09-2009
• Subjects: Aged; Aged, 80 and over; Brain - physiopathology; Brain Mapping; Carotid Arteries - physiopathology; carotid artery; Cerebral Revascularization - adverse effects; Diagnostic Imaging; Humans; Image Processing, Computer-Assisted; magnetic resonance imaging; Male; Nervous System Diseases - etiology; Nervous System Diseases - physiopathology; Reperfusion Injury - complications; Reperfusion Injury - physiopathology; revascularization
• ISSN: 1351-5101; 1468-1331; 1471-0552
• DOI: 10.1111/j.1468-1331.2009.02650.x

Background and purpose:  Some patients develop major neurological complications after carotid revascularization procedures, despite the lack of new infarcts or classical hyperperfusion syndrome.
Methods:  In four patients who developed major neurological deficits after carotid revascularization procedures, but without evidence of new ischemic infarcts or hyperperfusion, we performed post‐procedural MRI [diffusion‐weighted image (DWI), perfusion‐weighted image (PWI), pre‐and post‐contrast fluid‐attenuated inversion recovery (FLAIR) image] immediately after and 1 day after the procedure.
Results:  Post‐gadolinium FLAIR images on 1 day after the procedures showed prominent leptomeningeal enhancements in the revascularized hemispheres. These radiological findings disappeared on follow‐up FLAIR images accompanied by the clinical improvement over the following several days after the procedures.
Conclusion:  Reperfusion syndrome may be associated with transient severe neurological deficits after carotid revascularization in patients without new ischemic events or classical hyperperfusion syndrome.