From the Department of Medical Imaging (B.-C.L., Y.-H.L., C.-W.L.), National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
From the Department of Medical Imaging (B.-C.L., Y.-H.L., C.-W.L.), National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
AJNR Am J Neuroradiol. 2018 Jul;39(7):1280-1285. doi: 10.3174/ajnr.A5672. Epub 2018 May 17.
Permanent common carotid artery and/or ICA occlusion is an effective treatment for carotid blowout syndrome. Besides postoperative thromboembolic infarction, permanent common carotid artery and/or ICA occlusion may cause borderzone infarction when the collateral flow to the deprived brain territory is inadequate. In this study, we aimed to test the predictive value of CTA for post-permanent common carotid artery and/or ICA occlusion borderzone infarction in patients with carotid blowout syndrome.
In this retrospective study, we included 31 patients undergoing unilateral permanent common carotid artery and/or ICA occlusion for carotid blowout syndrome between May 2009 and December 2016. The vascular diameter of the circle of Willis was evaluated using preprocedural CTA, and the risk of borderzone infarction was graded as very high risk, high risk, intermediate risk, low risk, and very low risk.
The performance of readers' consensus on CTA for predicting borderzone infarction was excellent, with an area under receiver operating characteristic curve of 0.938 (95% confidence interval, 0.85-1.00). We defined very high risk, high risk, and intermediate risk as positive for borderzone infarction, the sensitivity, specificity, positive predictive value, and negative predictive value of CTA for borderzone infarction were 100% (7/7), 62.5% (15/24), 43.8% (7/16), and 100% (15/15), respectively. The interobserver reliability was excellent (κ = 0.807). No significant difference in the receiver operating characteristic curves was found between the 2 readers ( = .114).
CTA can be used to predict borderzone infarction after permanent common carotid artery and/or ICA occlusion by measuring the collateral vessels of the circle of Willis.
永久性颈总动脉和/或颈内动脉闭塞是颈动脉破裂综合征的有效治疗方法。除术后血栓栓塞性梗死外，当向缺血性脑区的侧支循环不足时，永久性颈总动脉和/或颈内动脉闭塞可能导致交界区梗死。在本研究中，我们旨在测试 CTA 对颈动脉破裂综合征患者永久性颈总动脉和/或颈内动脉闭塞后交界区梗死的预测价值。
本回顾性研究纳入了 2009 年 5 月至 2016 年 12 月期间因颈动脉破裂综合征行单侧永久性颈总动脉和/或颈内动脉闭塞的 31 例患者。使用术前 CTA 评估 Willis 环的血管直径，并将交界区梗死的风险分级为极高危、高危、中危、低危和极低危。
读者对 CTA 预测交界区梗死的一致性表现出色，受试者工作特征曲线下面积为 0.938（95%置信区间，0.85-1.00）。我们将极高危、高危和中危定义为交界区梗死阳性，CTA 对交界区梗死的敏感性、特异性、阳性预测值和阴性预测值分别为 100%（7/7）、62.5%（15/24）、43.8%（7/16）和 100%（15/15）。观察者间可靠性极佳（κ=0.807）。两名观察者的受试者工作特征曲线之间无显著差异（=0.114）。
通过测量 Willis 环的侧支血管，CTA 可用于预测永久性颈总动脉和/或颈内动脉闭塞后交界区梗死。
