Department of Neuroradiology, Saarland University Hospital, Kirrberger Straße, 66421, Homburg, Germany.
Neurol Sci. 2021 Jun;42(6):2391-2396. doi: 10.1007/s10072-020-04798-4. Epub 2020 Oct 14.
Tandem occlusions can complicate medical and endovascular stroke treatment. To identify these occlusions, computed tomography angiography (CTA) represents the best imaging modality. However, CTA is still not initially performed in some patients not admitted directly to stroke centers. Early identification of an additional occlusion of the proximal extracranial internal carotid artery may improve the best suitable treatment strategy. The purpose of this study was to find a valuable threshold of thrombus attenuation in a non-contrast head CT (NCCT) scan to facilitate a safe diagnosis of tandem occlusions.
Consecutive patients with acute middle cerebral artery (MCA) occlusions who underwent endovascular treatment were identified from our registry of neuroendovascular interventions. Thrombus attenuations of the affected MCA and contralateral vessel were measured by NCCT. To compare individual baseline blood attenuations, the difference between the thrombus attenuation and the contralateral MCA attenuation (referred to as ΔTM) was calculated.
Three hundred and twenty-five patients were included. There was a highly significant difference between mean thrombus attenuation with isolated MCA occlusion and additional extracranial internal carotid artery (ICA) occlusion (49.9 ± 8 vs. 56.2 ± 10 Hounsfield units (HU); P < 0.001). The area under the receiver operating characteristic curve of ΔTM was 0.72. The optimal threshold value was 13.5 HU, with a sensitivity of 67.5% and a specificity of 68.6%.
Despite a significant difference in thrombus attenuation in MCA occlusions with an additional extracranial ICA occlusion compared with isolated MCA occlusions, a relevant threshold of thrombus attenuation was not found.
串联闭塞可使内科和血管内治疗变得复杂。为了识别这些闭塞，计算机断层血管造影（CTA）是最佳的成像方式。然而，一些没有直接收入卒中中心的患者并未初始进行 CTA。早期识别颈内动脉颅外段近端的附加闭塞可能会改善最佳治疗策略。本研究旨在寻找非对比头部 CT（NCCT）扫描中血栓衰减的有价值阈值，以方便安全地诊断串联闭塞。
连续纳入在我们的神经血管介入登记处接受血管内治疗的急性大脑中动脉（MCA）闭塞患者。通过 NCCT 测量受累 MCA 和对侧血管的血栓衰减。为了比较个体的基线血液衰减值，计算了血栓衰减与对侧 MCA 衰减之间的差异（称为ΔTM）。
共纳入 325 例患者。孤立性 MCA 闭塞与附加颈内动脉（ICA）闭塞的平均血栓衰减值之间存在显著差异（49.9±8 与 56.2±10 亨氏单位（HU）；P<0.001）。ΔTM 的受试者工作特征曲线下面积为 0.72。最佳阈值为 13.5 HU，灵敏度为 67.5%，特异性为 68.6%。
尽管附加颈内动脉 ICA 闭塞的 MCA 闭塞的血栓衰减值存在显著差异，但未发现相关的血栓衰减阈值。
