Functional MRI evaluation of the effect of carotid artery stenting: a case study demonstrating cognitive improvement. (February 2021)

• Record Type: Journal Article
• Authors: Chinda, Betty; Liang, Simon; Siu, William; Medvedev, George; Song, Xiaowei
• Is Part Of: Acta radiologica open. Volume 10:Number 2(2021)
• Publication Date: 2021-02
• Subjects: Carotid stenosis -- carotid angioplasty and stenting -- task-phase functional magnetic resonance imaging -- stroke -- cognitive function -- prospective case study; Radiology -- Periodicals; Diagnostic Imaging -- Periodicals; Radiology; Periodicals; 616.075705
• DOI: 10.1177/2058460120988822
• Languages: English
• ISSNs: 2058-4601

Abstract

Background: The narrowing of the carotid arteries with plaque formation represents a major risk factor for ischemic stroke and cognitive impairments. Carotid angioplasty and stenting is a standard clinical treatment to reduce stroke risk. The cognitive effect of carotid angioplasty and stenting remains largely unknown. Purpose: This study aims to provide direct evidence of possible effects of carotid angioplasty and stenting on cognition, using task-phase functional magnetic resonance imaging. Material and Methods: This study received harmonized institutional ethics board approval (Grant number REB ID =H18-02495/FHREB 2018-058). Two patients had MRI scans pre-carotid angioplasty and stenting and two-month post-carotid angioplasty and stenting. Case 1 had severe (>95%) flow-limiting stenosis in the right carotid artery. Case 2 had 70% non-flow limiting stenosis in the left carotid artery. At each scan, patients completed two functional magnetic resonance imaging sessions while performing a working memory task. Accuracy, reaction time, and brain activation were analyzed for each patient for possible pre-post carotid angioplasty and stenting changes. Results: Case 1 showed increased activation in the right (treated-side) frontal and temporal lobes post-carotid angioplasty and stenting; associated with improvements in accuracy (from 58% to 74%) and task completion rate (from 17% to 72%). Case 2 completed the tasks pre- and post-carotid angioplasty and stenting with >90% accuracy, while decreased functional magnetic resonance imaging activation in the contralateral (untreated) hemisphere and mildly increased activation in the left (treated -side) anterior circulation territory were observed post-carotid angioplasty and stenting. Conclusion: These cases provided the first task-phase functional magnetic resonance imaging data demonstrating that carotid angioplasty and stenting improved cognitive function in the re-perfused vascular territory. The finding supports the role of carotid angioplasty and stenting in improving cognitive performance beyond reducing stroke risk.