MRI IN THE DIAGNOSIS OF RARE COMPLICATIONS OF CAROTID
ANGIOPLASTY WITH STENTING
Stegura D.S., Annushkin V.A., Ryabinkina Yu.V., Polischuk R.V., Konovalov R.N.,
Krotenkova M.V., Kremneva E.I.
Research Center of Neurology and Neurosciences. Moscow, Russia.
Endovascular methods of treatment of stenotic processes of internal carotid arteries are an effective method of prevention of primary and secondary stroke. Some patients after carotid angioplasty with stenting in the early postoperative period may develop neurologic symptoms: headache, convulsive seizures, focal neurologic symptoms, disorders of consciousness, disorientation and psychomotor agitation. Instrumental diagnostic methods, in particular MRI of the brain – may not reveal pathological changes explaining the development of these symptoms (ischemic and/or hemorrhagic), but when administering a contrast agent and performing a T2 FLAIR pulse sequence, a leptomeningeal type of contrast enhancement may be detected, which is not visualized in the mode of T1 weighted images.
Purpose. Detection of brain changes in patients in the early postoperative period after carotid angioplasty with stenting.
Materials and Methods. The study included 38 patients after carotid angioplasty with stenting performed on the basis Research Center of Neurology and Neurosciences. MRI examination was performed on Philips Panorama 1.0T and Siemens Magnetom Avanto 1.5T. Along with standard pulse sequences (T2WI, T1WI, T2 FLAIR, T2 hemo, DWI, T1WI+CE), the T2 FLAIR mode with contrast enhancement was added to the MRI protocol. The contrast agent gadobutrol at the rate of 0.1 mmol/kg of the patient's body weight was used.
Results. Patients were divided into 2 groups – without and with the development of neurologic symptoms. The first group included 31 patients, the second group included 7 patients. In the group of patients with the development of neurological symptoms in the early postoperative period, more than half of the cases showed psychomotor agitation and disorientation, and to a lesser extent sensorimotor aphasia, episodes of anxiety, hallucinations, and hemiparesis. When MRI of the brain was performed in 3 out of 7 (42.8%) patients, small foci of acute ischemia of cortical and subcortical localization were detected. In 6 out of 7 patients leptomeningeal contrast enhancement in T2 FLAIR mode was detected, in 1 patient there was no accumulation. In the group of patients without neurological symptoms development the foci of acute ischemia of different localization were observed in 11 out of 31 (35.5%) cases, no contrast agent accumulation was detected in Т1 WI and Т2 FLAIR modes.
Discussion. Post-contrast T2 FLAIR imaging plays an important role in the evaluation of patients during the first 24 hours after carotid artery stenting when neurological symptoms develop. It allows detection of areas of leptomeningeal contrast enhancement, whereas standard MRI sequences, including DWI and T2 hemo, usually do not demonstrate pathological changes that could explain the clinical symptoms. The detection of leptomeningeal enhancement on T2 FLAIR is possible due to its sensitivity to low concentrations of contrast agent as well as to minimal changes in cerebrospinal fluid composition. The mechanism of leptomeningeal contrast enhancement after carotid artery stenting has not yet been fully elucidated. Some authors suggest that blood-brain barrier disruption is related to abrupt hemodynamic changes after the procedure as a manifestation of hyperperfusion, whereas others interpret this phenomenon as a toxic effect of the iodinated contrast agent used during angiographic examination, similar to contrast-induced encephalopathy. There is reason to believe that these changes should be regarded as a combination of both processes. According to the literature, leptomeningeal contrast enhancement on T2 FLAIR may also be observed in patients without neurological symptoms; however, no such patients were identified in our study, most likely due to the small sample size.
Conclusion. The factors that may influence the development of neurological symptoms and the appearance of leptomeningeal accumulation of contrast agent in patients in the early postoperative period after stenting of internal carotid arteries require further study. Based on the obtained data, it is reasonable to perform MRI of the brain in T2 FLAIR mode with contrast enhancement in all patients with the development of neurologic symptoms after carotid angioplasty with stenting.
Keywords: carotid angioplasty with stenting, internal carotid artery, magnetic resonance imaging, contrast agent, T2 FLAIR, leptomeningeal contrast enhancement.
Corresponding author: Stegura D.S., e-mail: Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript
For citation: Stegura D.S., Annushkin V.A., Ryabinkina Yu.V., Polischuk R.V., Konovalov R.N., Krotenkova M.V., Kremneva E.I. MRI in the diagnosis of rare complications of carotid angioplasty with stenting. REJR 2026; 16(1):20-33. DOI: 10.21569/2222-7415-2026-16-1-20-33.
Received: 27.03.26 Accepted: 06.05.26