False-negative magnetic resonance angiography with extracranial internal carotid artery stenosis: A report of two cases and review of the literature

Wayne M. Gluf, Brent O'Neill, William T. Couldwell

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Magnetic resonance angiography (MRA) is increasingly used as a noninvasive means to assess internal carotid artery (ICA) stenosis. When used alone, however, MRA may not be sufficiently accurate in certain settings to determine whether ICA disease meets surgical criteria. Although MRA has been recognized to overestimate the degree of stenosis, the authors present two cases in which it severely underestimated arterial stenosis. Two male patients, 70 and 40 years old, respectively, were admitted with crescendo transient ischemic attacks. Their MRA studies suggested nonsurgical lesions of the ICA. After the patients continued to demonstrate clinical evidence of embolic disease, digital subtraction angiography (DSA) was performed on one patient, and the other received a gadolinium contrast-enhanced MRA. These tests revealed critical stenosis in each patient. Each was taken to the operating room for awake carotid endarterectomy with heparin anticoagulation and electroencephalographic monitoring. At surgery, both patients were found to have severely stenosed ICAs with complex plaques. MRA to determine whether ICA stenosis meets surgical criteria may not be sufficiently accurate in certain clinical settings. Additional imaging studies, such as confirmatory digital ultrasonography, MRA with gadolinium contrast, or DSA, may be required to determine the extent of carotid artery stenosis accurately.

Original languageEnglish (US)
Pages (from-to)154-158
Number of pages5
JournalNeurosurgical Review
Volume28
Issue number2
DOIs
StatePublished - Apr 2005

Fingerprint

Magnetic Resonance Angiography
Carotid Stenosis
Pathologic Constriction
Digital Subtraction Angiography
Gadolinium
Carotid Artery Diseases
Carotid Endarterectomy
Transient Ischemic Attack
Internal Carotid Artery
Operating Rooms
Heparin
Ultrasonography

Keywords

  • Internal carotid artery stenosis
  • MR angiography
  • TIA

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

False-negative magnetic resonance angiography with extracranial internal carotid artery stenosis : A report of two cases and review of the literature. / Gluf, Wayne M.; O'Neill, Brent; Couldwell, William T.

In: Neurosurgical Review, Vol. 28, No. 2, 04.2005, p. 154-158.

Research output: Contribution to journalArticle

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