Neurology Department, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Radiology Department, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
J Neurointerv Surg. 2018 Jul;10(7):653-656. doi: 10.1136/neurintsurg-2017-013169. Epub 2017 Nov 3.
Extracranial internal carotid artery (ICA) occlusion can be overestimated on emergent single phase CT angiography (CTA) of stroke patients with isolated intracranial ICA occlusion. We aimed to measure the ability of identifying the extracranial site of presumed tandem ICA occlusions on pre-procedural CTA relative to catheter angiography during acute endovascular stroke therapy.
Retrospective study of patients with intracranial ICA occlusion, with or without extracranial ICA occlusion, who underwent single phase CTA before acute endovascular treatment. Two neuroradiologists reviewed CTA images for the presence or absence of extracranial ICA occlusion, blinded to the catheter angiography results. The sensitivity, specificity, and predictive values of presumed extracranial ICA occlusions on CTA were calculated in reference to catheter angiography.
91 stroke patients with acute intracranial ICA occlusion met the inclusion criteria for the study. 24% of patients (22/91) had tandem ICA occlusion confirmed on catheter angiography. Single phase CTA had a sensitivity of 95.5% (95% CI 77.2 to 99.9%) and a specificity of 69.6% (95% CI 57.3 to 80.1%) for concomitant extracranial ICA occlusion (false positive rate 30.4%). The positive and negative predictive values of single phase CTA for extracranial ICA occlusion in the presence of a distal ICA occlusion were 50% (95% CI 34.2 to 65.8%) and 98% (95% CI 89.1 to 100%), respectively.
Emergency single phase CTA is highly sensitive but has reduced specificity to identify extracranial ICA occlusion in patients with intracranial ICA occlusion, which may confound planning for acute endovascular stroke therapy and cause over exclusion of patients with isolated ICA terminus occlusion from clinical trials.
在孤立性颅内颈内动脉（ICA）闭塞的脑卒中患者中，紧急单相 CT 血管造影（CTA）可能高估颅外 ICA 闭塞。我们旨在测量在急性血管内卒中治疗中，与导管血管造影术相比，术前 CTA 识别假定串联 ICA 闭塞的颅外部位的能力。
对接受急性血管内治疗前进行单相 CTA 检查的颅内 ICA 闭塞伴或不伴颅外 ICA 闭塞的患者进行回顾性研究。两名神经放射科医生对 CTA 图像进行评估，以确定是否存在颅外 ICA 闭塞，而不了解导管血管造影术的结果。以导管血管造影术为参考，计算 CTA 上假定颅外 ICA 闭塞的灵敏度、特异性和预测值。
91 例急性颅内 ICA 闭塞的脑卒中患者符合本研究的纳入标准。24%的患者（22/91）经导管血管造影术证实存在串联 ICA 闭塞。单相 CTA 对同时存在颅外 ICA 闭塞的敏感性为 95.5%（95%CI 77.2%至 99.9%），特异性为 69.6%（95%CI 57.3%至 80.1%）（假阳性率 30.4%）。在存在远端 ICA 闭塞的情况下，单相 CTA 对颅外 ICA 闭塞的阳性和阴性预测值分别为 50%（95%CI 34.2%至 65.8%）和 98%（95%CI 89.1%至 100%）。
紧急单相 CTA 高度敏感，但特异性降低，无法识别颅内 ICA 闭塞患者的颅外 ICA 闭塞，这可能会干扰急性血管内卒中治疗的计划，并导致将孤立性 ICA 末端闭塞的患者过度排除在临床试验之外。
