This study will use magnetic resonance imaging (MRI) to determine if silent strokes occur
during angioplasty of the blood vessels in the neck or skull. Neck and skull angioplasties
are relatively new procedures whose possible complications are still under investigation.
Patients 18 years of age or older who are admitted to Suburban Hospital in Bethesda,
Maryland, for angioplasty of one or more of the blood vessels in the neck or skull may
participate in this study. Participants must be able to undergo a brain MRI. Within 24
hours before their angioplasty, patients will provide a medical history and have a physical
examination and brain MRI. The physical examination and MRI will be repeated within 24
hours after the angioplasty.
MRI is a diagnostic test that uses a magnetic field and radio waves to show structural and
chemical changes in tissues. This technique is more sensitive than X-rays in detecting some
changes that occur in diseases of the brain. For the procedure, the patient lies on a table
that slides into a metal cylinder (the scanner). The confined space may produce anxiety in
some patients, and patients can talk to the technician at all times during the procedure.
Earplugs are provided to muffle loud knocking and pulsing noises that occur while the
scanner is taking pictures. During the study, the contrast material gadolinium may be
injected into an arm vein. Gadolinium "brightens" the pictures, producing better images of
brain blood flow.
Patients will be contacted by telephone 30 days after the procedure to follow how they are
doing and learn whether any complications resulted from the angioplasty.
Recently cervico-cranial angioplasty and stenting (CCAS) has been introduced as alternative
treatment for occlusive disease of the extracranial and the intracranial vessels. Temporary
or permanent clinically detectable neurological deficits occur in up to 13% of all patients
undergoing CASS and are usually related to distal embolization or hemodynamic insufficiency.
Silent cerebral micro-emboli are known to occur in patients undergoing carotid
endarterectomy and angioplasty but are believed to be of little clinical significance.
Distal embolization may be a technical concern when performing CCAS and could cause silent
cerebral ischemia. High resolution diffusion-weighted MRI may detect silent hyperacute
ischemic lesions in patients undergoing CCAS and examination by a stroke neurologist may
detect clinical deficits otherwise unrecognized.
Men and women age 18 years or older admitted for angioplasty with or without stenting of
any intra or extra-cranial vessel.
Any MRI contraindication (insulin pump, aneurysm clips, implanted neural stimulator,
cardiac pacemaker or defibrillator, cochlear implant, metal shrapnel or bullet)
Patients with hyperperfusion syndrome following the angioplasty.
Patients with cardiovascular or respiratory instability.
Patients with severe peri-procedural stroke at risk for herniation.
Confused or encephalopathic patients who are unable to cooperate.