Preoperative imaging evaluation of interventional therapy for patients with symptomatic intracranial artery stenosis

Objective: To investigate the value of comprehensive preoperative imaging evaluation in determining indication of intervention for patients with symptomatic intracranial artery stenosis. Methods: DSA, high-resolution MRI of plaque and computed tomography perfusion (CTP) or perfusion weighted imaging (PWI) were performed in 26 patients with symptomatic intracranial artery stenosis and the intracranial artery cavity, artery wall and cerebral perfusion were evaluated. For patients with atherosclerotic plaque, the plaque characterization was analyzed according to high-resolution MRI findings, and intervention was used for those with unstable plaque. However, medicine was used for patients with arteritis. All patients were followed up after therapy. Results: Combining with DSA, the stenosis in 18 cases was thought to be associated with atherosclerotic plaque, which showed eccentric stenosis with mild or no enhancement on MRI; 13 of them had symptomatic unstable plaques, 1 case showed stable plaque but cerebral perfusion damaged severely, all of them were treated with interventional therapy; the other 4 cases had stable plaques and treated with medicine. The stenosis in 8 patients, which showed concentric hypertrophy of local endangium on MRI, was caused by arteritis and treated with medicine. No ischemic events occurred during the following 1-8 months [average (5.2±3.1) months] after therapy. Conclusion: Comprehensive preoperative imaging evaluation for patients with symptomatic intracranial artery stenosis is of great value in guiding the therapy. (authors)