From the Department of Neurology, National Medical Center, Seoul, Korea (J.-H.B.); Departments of Radiology (B.M.K., D.J.K.) and Neurology (J.-H.B., J.Y., H.S.N., Y.D.K., J.H.H.), Yonsei University College of Medicine, Seoul, Korea; Department of Neurology, Sungkyunkwan University School of Medicine, Seoul, Korea (O.Y.B.); and Department of Neurology, Keimyung University College of Medicine, Daegu, Korea (J.Y.).
Stroke. 2017 Oct;48(10):2746-2752. doi: 10.1161/STROKEAHA.117.018096. Epub 2017 Sep 1.
We investigated whether occlusion type identified with computed tomography angiography (CTA-determined occlusion type) could predict endovascular treatment success using stent retriever (SR) thrombectomy.
Consecutive patients with stroke who underwent CTA and then endovascular treatment for intracranial large artery occlusion were retrospectively reviewed. CTA-determined occlusion type was classified into truncal-type occlusion or branching-site occlusion and compared with digital subtraction angiography-determined occlusion type during endovascular treatment. Three rapidly- and readily-assessable pre-procedural findings (CTA-determined occlusion type, atrial fibrillation, and hyperdense artery sign), which may infer occlusion pathomechanism (embolic versus nonembolic) before endovascular treatment, were evaluated for association with SR success along with stroke risk factors and laboratory results. In addition, the predictive power of the 3 pre-procedural findings for SR success was compared with receiver operating characteristic curve analyses.
A total of 238 patients (mean age, 70.0 years; male patients, 52.9%) were included in this study. CTA-determined occlusion type corresponded adequately with digital subtraction angiography-determined occlusion type (=0.453). Atrial fibrillation (odds ratio, 2.66; 95% confidence interval, 1.25-5.66) and CTA-determined branching-site occlusion (odds ratio, 8.20; confidence interval, 3.45-19.5) were independent predictors for SR success. For predicting SR success, the area under the receiver operating characteristic curve value for CTA-determined branching-site occlusion (0.695) was significantly greater than atrial fibrillation (0.594; =0.038) and hyperdense artery sign (0.603; =0.023).
CTA-determined branching-site occlusion was significantly associated with SR success. Furthermore, among the 3 rapidly- and readily-assessable pre-procedural findings, CTA-determined branching-site occlusion had the greatest predictive power for SR success.
我们研究了计算机断层血管造影（CTA 确定的闭塞类型）确定的闭塞类型是否可以预测使用支架取栓（SR）血栓切除术的血管内治疗成功。
回顾性分析了连续接受 CTA 检查后接受血管内治疗颅内大动脉闭塞的中风患者。将 CTA 确定的闭塞类型分为主干型闭塞或分支部位闭塞，并与血管内治疗期间的数字减影血管造影（DSA）确定的闭塞类型进行比较。评估了 3 种快速且易于评估的术前发现（CTA 确定的闭塞类型、心房颤动和高密度动脉征），这些发现可能在血管内治疗前推断出闭塞的发病机制（栓塞与非栓塞），并与 SR 成功以及中风危险因素和实验室结果相关联。此外，还通过接受者操作特征曲线分析比较了 3 种术前发现对 SR 成功的预测能力。
本研究共纳入 238 例患者（平均年龄 70.0 岁；男性患者占 52.9%）。CTA 确定的闭塞类型与 DSA 确定的闭塞类型相当（=0.453）。心房颤动（优势比，2.66；95%置信区间，1.25-5.66）和 CTA 确定的分支部位闭塞（优势比，8.20；置信区间，3.45-19.5）是 SR 成功的独立预测因素。对于预测 SR 成功，CTA 确定的分支部位闭塞的接受者操作特征曲线下面积值（0.695）明显大于心房颤动（0.594；=0.038）和高密度动脉征（0.603；=0.023）。
CTA 确定的分支部位闭塞与 SR 成功显著相关。此外，在 3 种快速且易于评估的术前发现中，CTA 确定的分支部位闭塞对 SR 成功具有最大的预测能力。
