Comparing different MR angiography strategies of carotid stents in a vascular flow model: toward stent-specific recommendations in MR follow-upReport as inadecuate

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, Volume 53, Issue 5, pp 359–365

First Online: 19 August 2010Received: 16 May 2010Accepted: 27 July 2010


IntroductionCarotid artery stenting CAS requires adequate follow-up imaging to assess complications such as in-stent stenosis or occlusion. Options include digital subtraction angiography, CT angiography, ultrasound, and MR angiography MRA, which may offer a non-invasive option for CAS follow-up imaging. The aim of this study was to assess contrast-enhanced MRA CE-MRA and three-dimensional time-of-flight MRA 3D-TOF for visualization of the in-stent lumen in different carotid stents.

MethodsIn this study, we compared CE-MRA and 3D-TOF of five different carotid stents Guidant Acculink®, Cordis Precise®, Boston Wallstent®, Abbot Vascular Xact®, Cook Zilver® in three diameters 4, 6, and 8 mm using a vascular flow model at 3.0 T with the help of a recently developed carotid surface coil. Stent-related artifacts were objectively assessed by calculating artificial lumen narrowing ALN and relative in-stent signal RIS.

ResultsRIS and ALN depended heavily on stent type, stent diameter, and the employed MR sequence. ALN and RIS were relatively favorable for Acculink®, Precise®, and Zilver® stents with both CE-MRA and 3D-TOF. CE-MRA provided better results for the Wallstent, while the Xact stent was difficult to visualize with both MRA protocols.

ConclusionBoth CE-MRA and 3D-TOF are viable options for depicting the in-stent lumen in carotid stents. For specific stents, 3D-TOF provided image quality comparable to CE-MRA and may thus be suitable for in vivo assessment. Development of stent-specific pathways for follow-up imaging seems advisable to address stent-related differences in image quality.

KeywordsThree-dimensional time-of-flight angiography Carotid stents MR angiography Artifacts Contrast-enhanced MR angiography Abbreviation KeyCASCarotid artery stenting

CE-MRAContrast-enhanced magnetic resonance angiography

CTAComputed tomography angiography

3D-TOFThree-dimensional time-of-flight angiography

ALNArtificial lumen narrowing

RISRelative in-stent signal

MRAMagnetic resonance angiography

DSADigital subtraction angiography

SISignal intensity


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Author: Andreas M. J. Frölich - Sara M. Pilgram-Pastor - Marios N. Psychogios - Alexander Mohr - Michael Knauth


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