[Role of magnetic resonance imaging in detecting the signs of internal carotid artery stenosis in the acute period of atherothrombotic ischemic stroke].

Objective: To determine the role of MRI in the choice of surgical approach in patients in the acute period of ischemic stroke (IS).

Materials And Methods: A single-center, prospective, observational, non-randomized study included 70 patients with non-disabling atherothrombotic left (lMCA) or right (rMCA) middle cerebral artery stroke combined with 50% or more ipsilateral internal carotid artery (ICA) stenosis. All 70 patients were candidates for early carotid revascularization of symptomatic ICA stenosis. All the patients underwent brain MRI 24-72 hours after admission, regardless of the presence or absence of an ischemic focus on the side of ICA stenosis, according to the initial CT.

Results: Signs of an ischemic focus, as detected by CT upon admission, were present in 12 (17.1%) patients, while 58 (82.9%) had no signs of ischemic brain damage. The subsequent MRI in 60 (85.7%) patients revealed an ischemic focus in the area of the symptomatic ICA stenosis blood supply, which corresponded to the clinical presentation of IS. In 4 (5.7%) patients, ischemic foci of various sizes were localized in both hemispheres of the brain, although the clinical presentation corresponded to only one side MCA stroke. In another 6 (8.6%) patients, a small ischemic focus was detected in the vertebral-basilar system (brainstem).

Conclusion: Patients with IS who are indicated for early carotid revascularization should undergo preoperative brain MRI, since 14.3% of patients who have a discrepancy between the clinical presentation and brain CT and MRI data require additional examination, the results of which can significantly change the surgical approach.