Hong Ji Man, Lee Sung Eun, Lee Seong-Joon, Lee Jin Soo, Demchuk Andrew M
Department of Neurology, School of Medicine, Ajou University, Suwon, South Korea Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.
Medicine (Baltimore). 2017 Feb;96(5):e5722. doi: 10.1097/MD.0000000000005722.
Noninvasive computed tomography angiography (CTA) is widely used in acute ischemic stroke, even for diagnosing various internal carotid artery (ICA) occlusion sites, which often need cerebral digital subtraction angiography (DSA) confirmation. We evaluated whether clinical outcomes vary depending on the DSA-based occlusion sites and explored correlating features on baseline CTA that predict DSA-based occlusion site.We analyzed consecutive patients with acute ICA occlusion who underwent DSA and CTA. Occlusion site was classified into cervical, cavernous, petrous, and carotid terminus segments by DSA confirmation. Clinical and radiological features associated with poor outcome at 3 months (3-6 of modified Rankin scale) were analyzed. Baseline CTA findings were categorized according to carotid occlusive shape (stump, spearhead, and streak), presence of cervical calcification, Willisian occlusive patterns (T-type, L-type, and I-type), and status of leptomeningeal collaterals (LMC).We identified 49 patients with occlusions in the cervical (n = 17), cavernous (n = 22), and carotid terminus (n = 10) portions: initial NIH Stroke Scale (11.4 ± 4.2 vs 16.1 ± 3.7 vs 18.2 ± 5.1; P < 0.001), stroke volume (27.9 ± 29.6 vs 127.4 ± 112.6 vs 260.3 ± 151.8 mL; P < 0.001), and poor outcome (23.5 vs 77.3 vs 90.0%; P < 0.001). Cervical portion occlusion was characterized as rounded stump (82.4%) with calcification (52.9%) and fair LMC (94.1%); cavernous as spearhead occlusion (68.2%) with fair LMC (86.3%) and no calcification (95.5%); and terminus as streak-like occlusive pattern (60.0%) with poor LMC (60.0%), and no calcification (100%) on CTA.Our study indicates that acute ICA occlusion can be subtyped into cervical, cavernous, and terminus. Distinctive findings on initial CTA can help differentiate ICA-occlusion subtypes with specific characteristics.
无创计算机断层血管造影（CTA）在急性缺血性卒中中被广泛应用，甚至用于诊断各种颈内动脉（ICA）闭塞部位，而这些部位通常需要脑数字减影血管造影（DSA）来确认。我们评估了临床结局是否因基于DSA的闭塞部位而异，并探索了基线CTA上预测基于DSA的闭塞部位的相关特征。我们分析了连续接受DSA和CTA检查的急性ICA闭塞患者。通过DSA确认，将闭塞部位分为颈部、海绵窦、岩骨和颈动脉末端节段。分析了与3个月时不良结局（改良Rankin量表评分为3 - 6分）相关的临床和影像学特征。根据颈动脉闭塞形态（残端、矛头状和条索状）、颈部钙化的存在、Willis环闭塞模式（T型、L型和I型）以及软脑膜侧支循环（LMC）的状态对基线CTA表现进行分类。我们确定了49例在颈部（n = 17）、海绵窦（n = 22）和颈动脉末端（n = 10）部位发生闭塞的患者：初始美国国立卫生研究院卒中量表评分（11.4±4.2 vs 16.1±3.7 vs 18.2±5.1；P < 0.001）、卒中体积（27.9±29.6 vs 127.4±112.6 vs 260.3±151.8 mL；P < 0.001）以及不良结局（23.5% vs 77.3% vs 90.0%；P < 0.001）。颈部闭塞的特征为圆形残端（82.4%）伴有钙化（52.9%）和良好的LMC（94.1%）；海绵窦为矛头状闭塞（68.2%）伴有良好的LMC（86.3%）且无钙化（95.5%）；末端为条索状闭塞模式（60.0%）伴有不良的LMC（60.0%），且CTA上无钙化（100%）。我们的研究表明，急性ICA闭塞可分为颈部、海绵窦和末端亚型。初始CTA上的独特表现有助于区分具有特定特征的ICA闭塞亚型。
