Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Fujian, China.
Neurosurgery. 2019 Jun 1;84(6):1296-1305. doi: 10.1093/neuros/nyy183.
The differentiation between intracranial atherosclerotic stenosis (ICAS) and intracranial embolism as the immediate cause of acute ischemic stroke requiring endovascular therapy is important but challenging. In cases of ICAS, we often observe a phenomenon we call the microcatheter "first-pass effect," which is temporary blood flow through the occluded intracranial artery when the angiographic microcatheter is initially advanced through the site of total occlusion and immediately retrieved proximally.
To evaluate whether this microcatheter first-pass effect can be used to differentiate ICAS from intracranial embolism.
A total of 61 patients with acute ischemic stroke resulting from large intracranial artery occlusion and in whom recanalization was achieved by endovascular treatment were included in the study. The microcatheter first-pass effect was tested in these patients. The sensitivity, specificity, positive predictive values (PPV), and accuracy of the microcatheter first-pass effect for prediction of ICAS were assessed.
The microcatheter first-pass effect was more frequently observed in patients with ICAS than in those with intracranial embolism (90.9% vs 12.8%, P < .001). For identifying ICAS, sensitivity, specificity, PPV, and accuracy of the microcatheter first-pass effect were 90.9%, 87.2%, 80.0%, 88.5%, respectively.
The sensitivity and PPV of the microcatheter first-pass effect are high for prediction of ICAS in patients with acute symptoms.
颅内动脉粥样硬化性狭窄（ICAS）与颅内栓塞作为需要血管内治疗的急性缺血性卒中的即刻病因的区分非常重要，但具有挑战性。在 ICAS 病例中，我们经常观察到一种被称为微导管“初次通过效应”的现象，即在血管造影微导管最初通过完全闭塞部位推进并立即近端收回时，闭塞颅内动脉的临时血流。
评估这种微导管初次通过效应是否可用于区分 ICAS 与颅内栓塞。
共纳入 61 例因颅内大血管闭塞导致急性缺血性卒中且经血管内治疗实现再通的患者。对这些患者进行了微导管初次通过效应测试。评估了微导管初次通过效应预测 ICAS 的敏感性、特异性、阳性预测值（PPV）和准确性。
ICAS 患者中微导管初次通过效应更常见（90.9% vs 12.8%，P <.001）。对于识别 ICAS，微导管初次通过效应的敏感性、特异性、PPV 和准确性分别为 90.9%、87.2%、80.0%和 88.5%。
急性症状患者中，微导管初次通过效应的敏感性和 PPV 对预测 ICAS 较高。
