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Research ArticleNeurointervention

Peritherapeutic Hemodynamic Changes of Carotid Stenting Evaluated with Quantitative DSA in Patients with Carotid Stenosis

M.M.H. Teng, F.-C. Chang, C.-J. Lin, L. Chiang, J.-S. Hong and Y.-H. Kao
American Journal of Neuroradiology October 2016, 37 (10) 1883-1888; DOI: https://doi.org/10.3174/ajnr.A4813
M.M.H. Teng
aFrom the Department of Medical Imaging (M.M.H.T.), Cheng Hsin General Hospital, Taipei, Taiwan
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F.-C. Chang
bDepartment of Radiology (F.-C.C., C.-J.L., L.C.), Taipei Veterans General Hospital, Taipei, Taiwan
cSchool of Medicine (F.-C.C., C.-J.L.)
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C.-J. Lin
bDepartment of Radiology (F.-C.C., C.-J.L., L.C.), Taipei Veterans General Hospital, Taipei, Taiwan
cSchool of Medicine (F.-C.C., C.-J.L.)
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L. Chiang
bDepartment of Radiology (F.-C.C., C.-J.L., L.C.), Taipei Veterans General Hospital, Taipei, Taiwan
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J.-S. Hong
dDepartment of Biomedical Imaging and Radiological Sciences (J.-S.H., Y.-H.K.), National Yang-Ming University, Taipei, Taiwan.
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Y.-H. Kao
dDepartment of Biomedical Imaging and Radiological Sciences (J.-S.H., Y.-H.K.), National Yang-Ming University, Taipei, Taiwan.
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Article Figures & Data

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    Fig 1.

    Color-coded DSA images in the PA (A) and lateral (B) views. Eleven ROIs are manually selected for quantification of perfusion parameters. ICA1 on the PA view and ICA1 on lateral view are planned to be at the same place.

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    Fig 2.

    The measured (blue open circle) and fitted (orange line) time-concentration curves. Hemodynamic parameters such as maximum enhancement, time to peak, bolus arrival time, wash-in slope, washout slope, and full width at half maximum are all derived from the fitted curve.

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    Fig 3.

    Measured (blue circle) and fitted (orange line) time-concentration curves of representative ROIs before the stent-placement treatment: ICA2 (A), M2 (B), PV (C), SSS (D). Note that the time-concentration curve of the PV (C) lacks the middle and lower descending portion. The ME in the time-concentration curve of the SSS (D) is at the last temporal point. AU indicates arbitrary unit.

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    Fig 4.

    A comparison of the time-concentration curves before and after the stent placement treatment for the ICA2 (A) and M2 (B) in the lateral view. The blue solid circles are measured data, and orange lines are the fitted curves before the treatment. The green solid circles and red lines are measured data and fitted curves, respectively, after treatment. AU indicates arbitrary unit.

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    Fig 5.

    Comparison of the mean BAT (blue, a–e) and mean TTP (red, f–i) before (upper line) and after (lower line) treatment for different vascular ROIs in the lateral view: ICA1 (a and f), ICA2 (b and g), M2 (c and h), PV (d and i), and SSS (e). The TTP and rTTP are reduced after treatment in the extracranial (a and f) and intracranial segments, being more obvious in segments between the ICA1 and the PV (a–d and f–i) and less obvious from PV to SSS (d and e).

Tables

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    Table 1:

    P values of all hemodynamic parameters before and after stenting at each ROIa

    ROI LocationsPA ViewLateral View
    ICA1ICA2M1A1IJVICA1ICA2M2A2PVSSS
    ME.27.11.15.79NA.68.99.20*.55NA
    TTP****NA*****NA
    rTTP–*b*b*bNA–*c*d*d*dNA
    BAT****.32******
    FWHM***.08NA****NANA
    WI.97.88.09.64.15.37.20.12.06.20NA
    WO****NA****NANA
    AUC**.06.39NA***.83NANA
    • Note:—NA indicates not available because of incomplete data; –, not calculated; *, significant difference before and after stenting (P < .05); IJV, internal jugular vein.

    • ↵a Details for significant results are shown in Tables 2 and 3.

    • ↵b TTP relative to ICA1 in the PA view.

    • ↵c TTP relative to ICA1 in the lateral view.

    • ↵d TTP relative to ICA2 in the lateral view.

    • View popup
    Table 2:

    Results for the hemodynamic parameters with significant changes (P < .05) after the stenting procedure in the PA view

    ROIBefore Treatment (Mean ± SD)After Treatment (Mean ± SD)No.
    TTP (sec)
        ICA12.89 ± 0.622.46 ± 0.2734
        ICA23.16 ± 0.702.60 ± 0.2534
        M13.70 ± 0.922.95 ± 0.3134
        A13.42 ± 0.672.95 ± 0.3718
    rTTP (sec)
        ICA1–ICA20.27 ± 0.220.14 ± 0.1334
        ICA1–M10.81 ± 0.430.49 ± 0.1834
        ICA1–A10.74 ± 0.250.54 ± 0.2318
    BAT (sec)
        ICA11.37 ± 0.291.15 ± 0.2034
        ICA21.63 ± 0.371.27 ± 0.2934
        M11.91 ± 0.481.49 ± 0.3134
        A11.85 ± 0.451.51 ± 0.3118
    FWHM (sec)
        ICA12.54 ± 0.811.95 ± 0.4634
        ICA22.53 ± 0.891.96 ± 0.5034
        M13.27 ± 0.912.62 ± 0.6334
    WO (AU/s)
        ICA1−209 ± 79−264 ± 8034
        ICA2−202 ± 80−247 ± 9134
        M1−86 ± 44−112 ± 4434
        A1−73 ± 29−90 ± 3018
    AUC (AU/sec)
        ICA11268 ± 426942 ± 32434
        ICA21188 ± 476866 ± 26934
    • Note:—No. indicates number of cases measured; AU, arbitrary unit.

    • View popup
    Table 3:

    Results for the hemodynamic parameters with significant changes (P < .05) after the stenting procedure in the lateral view

    ROIBefore Treatment (Mean ± SD)After Treatment (Mean ± SD)No.
    TTP (sec)
        ICA12.96 ± 0.692.47 ± 0.2534
        ICA23.30 ± 0.812.66 ± 0.2734
        M23.98 ± 0.983.15 ± 0.3034
        A23.70 ± 0.882.97 ± 0.4117
        PV8.01 ± 1.286.79 ± 0.6830
    rTTP (sec)
        ICA1–ICA20.34 ± 0.240.19 ± 0.1334
        ICA2–M20.68 ± 0.250.50 ± 0.1634
        ICA2–A20.66 ± 0.380.34 ± 0.1717
        ICA2–PV4.73 ± 1.004.14 ± 0.6930
        M2–PV4.06 ± 0.933.67 ± 0.6530
    BAT (sec)
        ICA11.39 ± 0.371.19 ± 0.2634
        ICA21.70 ± 0.371.33 ± 0.2934
        M22.14 ± 0.541.65 ± 0.3434
        A22.17 ± 0.691.74 ± 0.3717
        PV4.88 ± 0.943.87 ± 0.6930
        SSS5.35 ± 1.534.39 ± 1.0934
    FWHM (sec)
        ICA12.66 ± 1.011.93 ± 0.4134
        ICA22.66 ± 0.932.01 ± 0.5034
        M23.22 ± 0.882.54 ± 0.6534
        A22.90 ± 0.842.27 ± 0.8317
    WO (AU/s)
        ICA1−217 ± 110−281 ± 9134
        ICA2−229 ± 91−305 ± 10734
        M2−90 ± 49−120 ± 4634
        A2−79 ± 37−116 ± 3417
    AUC (AU/sec)
        ICA11413 ± 6921002 ± 34034
        ICA21561 ± 7531160 ± 38534
        M2879 ± 377750 ± 29934
    ME (AU)
        A2203 ± 74234 ± 7217
    • Note:—No. indicates number of cases measured; AU, arbitrary unit.

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American Journal of Neuroradiology: 37 (10)
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M.M.H. Teng, F.-C. Chang, C.-J. Lin, L. Chiang, J.-S. Hong, Y.-H. Kao
Peritherapeutic Hemodynamic Changes of Carotid Stenting Evaluated with Quantitative DSA in Patients with Carotid Stenosis
American Journal of Neuroradiology Oct 2016, 37 (10) 1883-1888; DOI: 10.3174/ajnr.A4813

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Peritherapeutic Hemodynamic Changes of Carotid Stenting Evaluated with Quantitative DSA in Patients with Carotid Stenosis
M.M.H. Teng, F.-C. Chang, C.-J. Lin, L. Chiang, J.-S. Hong, Y.-H. Kao
American Journal of Neuroradiology Oct 2016, 37 (10) 1883-1888; DOI: 10.3174/ajnr.A4813
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