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Arterial spin labeling MRI in patients undergoing carotid artery revascularization: a systematic review of the hemodynamic changes and clinical implications.

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Title: Arterial spin labeling MRI in patients undergoing carotid artery revascularization: a systematic review of the hemodynamic changes and clinical implications.
Authors: Carrozzi, Alessandro1 (AUTHOR), Manfrini, Elia2 (AUTHOR), Golini, Carlo3 (AUTHOR), Pastore, Luigi Vincenzo1 (AUTHOR), Vitale, Annalisa4 (AUTHOR), Bartolo, Pietro5 (AUTHOR), Requena, Manuel6,7 (AUTHOR), Diana, Francesco6,7,8 (AUTHOR), de Dios Lascuevas, Marta6 (AUTHOR), Testa, Claudia3 (AUTHOR), Cirillo, Luigi9,10 (AUTHOR), Hernández, David6 (AUTHOR), Auger, Cristina5,7 (AUTHOR), Rovira, Àlex5,7 (AUTHOR), Tomasello, Alejandro6,7 (AUTHOR), Gramegna, Laura Ludovica7,11 (AUTHOR) laura.gramegna@vhir.org
Source: European Radiology. Feb2026, Vol. 36 Issue 2, p916-927. 12p.
Subjects: Carotid artery stenosis, Hyperperfusion, Carotid artery, Magnetic resonance imaging, Collateral circulation, Hemodynamics, Perfusion magnetic resonance imaging, Cerebral circulation
Abstract: Objectives: Arterial spin labeling (ASL) MRI is a non-invasive imaging modality that measures cerebral blood flow (CBF) without the need for contrast agents or radiation, offering insights into hemodynamic changes. Carotid revascularization procedures, carotid endarterectomy and carotid artery stenting, aim to improve cerebral perfusion and reduce the risk of ischemic events. This study explores ASL's clinical potential in assessing CBF changes in carotid stenosis patients prior to revascularization procedures. Materials and methods: A systematic review was conducted following PRISMA guidelines to identify studies that utilized ASL in patients undergoing carotid revascularization. Searches were performed in the MEDLINE/PubMed and Web of Science databases. Extracted data included patient demographics, ASL acquisition parameters, perfusion analysis methods, and study findings related to ASL results. Results: Twenty studies involving 710 patients were included. Preoperative ASL consistently identified perfusion deficits ipsilateral to stenosis, which improved post-revascularization, particularly in eloquent brain regions. After revascularization, CBF increase was greatest in patients with severe baseline deficits and smaller in those with prior strokes. ASL metrics predicted post-procedural cerebral hyperperfusion (CH), though protocol variability influenced results. Visual assessment methods based on arterial transit artifacts (ATA) emerged as practical tools for hyperperfusion risk prediction without requiring extensive post-processing. Conclusion: ASL MRI is a valuable tool for assessing hemodynamic changes in carotid artery stenosis and predicting treatment outcomes, particularly the risk of hyperperfusion. Its non-invasive nature and ability to evaluate collateral flow enhance its clinical value. Key Points: QuestionCan arterial spin labeling (ASL) MRI reliably assess cerebral blood flow changes in patients with carotid stenosis undergoing revascularization, improving decision-making regarding risks and outcomes? FindingsASL detects pre-treatment perfusion deficits, quantifies post-revascularization blood flow increases, predicts hyperperfusion risk, and assesses collateral flow in carotid stenosis patients undergoing endarterectomy or stenting. Clinical relevanceASL MRI provides a non-invasive method to evaluate cerebral perfusion in carotid stenosis, aiding in risk assessment for cerebral hyperperfusion syndrome and optimizing treatment strategies by preoperatively assessing collateral circulation and post-treatment cerebral blood flow recovery. [ABSTRACT FROM AUTHOR]
Copyright of European Radiology is the property of Springer Nature and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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  Data: Arterial spin labeling MRI in patients undergoing carotid artery revascularization: a systematic review of the hemodynamic changes and clinical implications.
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  Data: <searchLink fieldCode="JN" term="%22European+Radiology%22">European Radiology</searchLink>. Feb2026, Vol. 36 Issue 2, p916-927. 12p.
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  Data: <searchLink fieldCode="DE" term="%22Carotid+artery+stenosis%22">Carotid artery stenosis</searchLink><br /><searchLink fieldCode="DE" term="%22Hyperperfusion%22">Hyperperfusion</searchLink><br /><searchLink fieldCode="DE" term="%22Carotid+artery%22">Carotid artery</searchLink><br /><searchLink fieldCode="DE" term="%22Magnetic+resonance+imaging%22">Magnetic resonance imaging</searchLink><br /><searchLink fieldCode="DE" term="%22Collateral+circulation%22">Collateral circulation</searchLink><br /><searchLink fieldCode="DE" term="%22Hemodynamics%22">Hemodynamics</searchLink><br /><searchLink fieldCode="DE" term="%22Perfusion+magnetic+resonance+imaging%22">Perfusion magnetic resonance imaging</searchLink><br /><searchLink fieldCode="DE" term="%22Cerebral+circulation%22">Cerebral circulation</searchLink>
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Objectives: Arterial spin labeling (ASL) MRI is a non-invasive imaging modality that measures cerebral blood flow (CBF) without the need for contrast agents or radiation, offering insights into hemodynamic changes. Carotid revascularization procedures, carotid endarterectomy and carotid artery stenting, aim to improve cerebral perfusion and reduce the risk of ischemic events. This study explores ASL's clinical potential in assessing CBF changes in carotid stenosis patients prior to revascularization procedures. Materials and methods: A systematic review was conducted following PRISMA guidelines to identify studies that utilized ASL in patients undergoing carotid revascularization. Searches were performed in the MEDLINE/PubMed and Web of Science databases. Extracted data included patient demographics, ASL acquisition parameters, perfusion analysis methods, and study findings related to ASL results. Results: Twenty studies involving 710 patients were included. Preoperative ASL consistently identified perfusion deficits ipsilateral to stenosis, which improved post-revascularization, particularly in eloquent brain regions. After revascularization, CBF increase was greatest in patients with severe baseline deficits and smaller in those with prior strokes. ASL metrics predicted post-procedural cerebral hyperperfusion (CH), though protocol variability influenced results. Visual assessment methods based on arterial transit artifacts (ATA) emerged as practical tools for hyperperfusion risk prediction without requiring extensive post-processing. Conclusion: ASL MRI is a valuable tool for assessing hemodynamic changes in carotid artery stenosis and predicting treatment outcomes, particularly the risk of hyperperfusion. Its non-invasive nature and ability to evaluate collateral flow enhance its clinical value. Key Points: QuestionCan arterial spin labeling (ASL) MRI reliably assess cerebral blood flow changes in patients with carotid stenosis undergoing revascularization, improving decision-making regarding risks and outcomes? FindingsASL detects pre-treatment perfusion deficits, quantifies post-revascularization blood flow increases, predicts hyperperfusion risk, and assesses collateral flow in carotid stenosis patients undergoing endarterectomy or stenting. Clinical relevanceASL MRI provides a non-invasive method to evaluate cerebral perfusion in carotid stenosis, aiding in risk assessment for cerebral hyperperfusion syndrome and optimizing treatment strategies by preoperatively assessing collateral circulation and post-treatment cerebral blood flow recovery. [ABSTRACT FROM AUTHOR]
– Name: AbstractSuppliedCopyright
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  Data: <i>Copyright of European Radiology is the property of Springer Nature and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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      – Type: doi
        Value: 10.1007/s00330-025-11885-7
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      – Code: eng
        Text: English
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        StartPage: 916
    Subjects:
      – SubjectFull: Carotid artery stenosis
        Type: general
      – SubjectFull: Hyperperfusion
        Type: general
      – SubjectFull: Carotid artery
        Type: general
      – SubjectFull: Magnetic resonance imaging
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      – SubjectFull: Collateral circulation
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      – SubjectFull: Hemodynamics
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      – SubjectFull: Perfusion magnetic resonance imaging
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      – SubjectFull: Cerebral circulation
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      – TitleFull: Arterial spin labeling MRI in patients undergoing carotid artery revascularization: a systematic review of the hemodynamic changes and clinical implications.
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              Text: Feb2026
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