Recently cervico-cranial angioplasty and stenting (CCAS) has been introduced as alternative treatment for occlusive disease of the extracranial and the intracranial vessels. Temporary or permanent clinically detectable neurological deficits occur in up to 13% of all patients undergoing CASS and are usually related to distal embolization or hemodynamic insufficiency. Silent cerebral micro-emboli are known to occur in patients undergoing carotid endarterectomy and angioplasty but are believed to be of little clinical significance. Distal embolization may be a technical concern when performing CCAS and could cause silent cerebral ischemia. High resolution diffusion-weighted MRI may detect silent hyperacute ischemic lesions in patients undergoing CCAS and examination by a stroke neurologist may detect clinical deficits otherwise unrecognized.
INCLUSION CRITERIA: Men and women age 18 years or older admitted for angioplasty with or without stenting of any intra or extra-cranial vessel. EXCLUSION CRITERIA: Any MRI contraindication (insulin pump, aneurysm clips, implanted neural stimulator, cardiac pacemaker or defibrillator, cochlear implant, metal shrapnel or bullet) Patients with hyperperfusion syndrome following the angioplasty. Patients with cardiovascular or respiratory instability. Patients with severe peri-procedural stroke at risk for herniation. Confused or encephalopathic patients who are unable to cooperate. Pregnant women. Lactating women