ANALYSIS OF MRI USAGE IN ISCHEMIC STROKE DIAGNOSTICS WITH LOW
NEUROLOGICAL DEFICIENCY IN PATIENTS AFTER PERCUTANEOUS
CORONARY INTERVENTIONS
Brodetsky B.M.1, Brylin K.V.1, Akhkubekova Z.A.1, Voynovskaya M.A.2, Ternovoy S.K.2,3
1 – L. A. Vorokhobova City Clinical Hospital No. 67
2 – Sechenov University.
3 – National Medical Research Center of Cardiology of the Ministry of Health of Russia. Moscow, Russia.
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espite the effectiveness of percutaneous coronary intervention (PCI), the occurrence of a stroke after the procedure remains a serious problem. The mechanisms of stroke development after PCI are associated with thromboembolism, cerebral hypoperfusion, embolization by fragments of atherosclerotic plaques during catheter manipulation, hypercoagulation and other factors. Further research is needed to improve strategies to reduce the risk of stroke after PCI and to improve patient outcomes.
Purpose. To conduct a preliminary analysis of the use of MRI in the diagnosis of acute cerebrovascular accident of the ischemic type with low neurological deficit in patients with chronic ischemic heart disease after percutaneous coronary interventions.
Materials and methods. This study included 36 patients (20 men and 16 women), each of whom underwent percutaneous coronary intervention for chronic ischemic heart disease (IHD). The average age of the patients was 68.67±10.56 years. All patients underwent MRI before and after surgery (PCI). During the study, the following parameters were analyzed: the presence of diabetes mellitus as an underlying disease; the degree of concomitant arterial hypertension; the presence of signs of stroke on MRI before surgery; the presence of signs of stroke on MRI after surgery; the number of stroke foci and their sizes on MRI after surgery.
Results. Signs of stroke on MRI before PCI were not observed in any patient. However, during performing MRI after surgery, such patients already became 9 (25.00%). It was determined that the use of MRI in the diagnosis of stroke of ischemic type with low neurological deficit in the patients after PCI can significantly increase the frequency of detection of signs of a stroke from 0% to 25.00% (p=0.00014).
Discussion. In clinical practice, patients with suspected acute ischemic stroke are recommended to undergo neuroimaging as soon as possible. CT without contrast is a rapid and reliable method for detecting a hemorrhagic stroke, but is five times less sensitive and two times less accurate for diagnosing early ischemic changes compared to MRI. The choice of CTA angiography for imaging in our case was not optimal, since the probability of thrombosis of a large cerebral vessel in patients with low neurological deficit (NIHSS< 6) was low. MRI is a method of choice in small ischemia detecting, which does not require a significant time expenditure.
Conclusion. Stroke is a rare but a serious complication of PCI that increases in-hospital mortality and morbidity. To reduce the risk of stroke after PCI, continued vigilance for this complication, risk stratification, and the use of preventive measures are necessary. The use of MRI in the diagnosis of stroke of ischemic type with low neurological deficit in patients after PCI can significantly increase the frequency of detection of signs of stroke. However, further studies are needed on large samples of patients to develop strategies for preventing stroke during PCI and improve treatment outcomes for patients with coronary artery disease.
Keywords: magnetic resonance imaging, stroke, lacunar ischemic stroke, percutaneous coronary intervention.
Corresponding author: Brodetsky B.M., e-mail: Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript
For citation: Brodetsky B.M., Brylin K.V., Akhkubekova Z.A., Voynovskaya M.A., Ternovoy S.K. Analysis of MRI usage in ischemic stroke diagnostics with low neurological deficiency in patients after percutaneous coronary interventions. REJR 2025; 15(1):62-72. DOI: 10.21569/2222-7415-2025-15-1-62-72
Received: 14.01.25 Accepted: 12.02.25