From the Departments of Diagnostic and Interventional Radiology and Neuroradiology (C.J.M., F.J., A.Berlis)
University Institute of Diagnostic and Interventional Neuroradiology (T.Dobrocky, J.G.), University of Bern, Inselspital, Bern, Switzerland.
AJNR Am J Neuroradiol. 2020 Mar;41(3):464-468. doi: 10.3174/ajnr.A6412. Epub 2020 Feb 6.
Large intracranial vessel occlusion due to calcified emboli is a rare cause of major stroke. We assessed the prevalence, imaging appearance, the effectiveness of mechanical thrombectomy, and clinical outcome of patients with large-vessel occlusion due to calcified emboli.
We performed a retrospective analysis of clinical and procedural data of consecutive patients who underwent mechanical thrombectomy due to calcified emboli in 7 European stroke centers.
We screened 2969 patients, and 40 patients matched the inclusion criteria, accounting for a prevalence of 1.3%. The mean maximal density of the thrombus was 327 HU (range, 150-1200 HU), and the mean thrombus length was 9.2 mm (range, 4-20 mm). Four patients had multiple calcified emboli, and 2 patients had an embolic event during an endovascular intervention. A modified TICI score of ≥2b was achieved in 57.5% (23/40), with minimal-to-no reperfusion (modified TICI 0-1) in 32.5% (13/40) and incomplete reperfusion (modified TICI 2a) in 10% (4/40). Excellent outcome (mRS 0-1) was achieved in only 20.6%, functional independence (mRS 0-2) in 26.5% and 90-day mortality was 55.9%.
Acute ischemic stroke with large-vessel occlusion due to calcified emboli is a rare entity in patients undergoing thrombectomy, with considerably worse angiographic outcome and a higher mortality compared with patients with noncalcified thrombi. Good functional recovery at 3 months can still be achieved in about a quarter of patients.
由钙化栓子引起的颅内大血管闭塞是导致大卒中和罕见原因。我们评估了因钙化栓子导致的大血管闭塞患者的患病率、影像学表现、机械血栓切除术的有效性和临床转归。
我们对 7 个欧洲卒中中心连续因钙化栓子行机械血栓切除术的患者的临床和程序数据进行了回顾性分析。
我们筛选了 2969 例患者，40 例符合纳入标准，患病率为 1.3%。血栓的最大密度平均值为 327HU（范围，150-1200HU），血栓长度平均值为 9.2mm（范围，4-20mm）。4 例患者有多个钙化栓子，2 例患者在血管内介入治疗期间发生栓塞事件。57.5%（23/40）患者达到改良 TICI 分级≥2b，32.5%（13/40）患者最小再灌注（改良 TICI 0-1），10%（4/40）患者不完全再灌注（改良 TICI 2a）。仅 20.6%（9/44）患者获得良好结局（mRS 0-1），26.5%（11/42）患者获得功能独立性（mRS 0-2），90 天死亡率为 55.9%。
接受血栓切除术的患者中，由钙化栓子引起的急性缺血性卒中伴大血管闭塞较为少见，与非钙化血栓患者相比，其血管造影结果明显较差，死亡率更高。约四分之一的患者仍能在 3 个月时获得良好的功能恢复。
