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.