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

Question Can 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? Findings ASL 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 relevance ASL 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.