Clinical Science, Neurosciences, Umeå University, 90182, Umeå, Sweden.
Wallenberg Centre for Molecular Medicine, Umeå University, 90182, Umeå, Sweden.
Neuroradiology. 2022 Jan;64(1):59-67. doi: 10.1007/s00234-021-02728-5. Epub 2021 May 4.
Create a new definition of near-occlusion with full collapse to predicting recurrent stroke.
Pooled analysis of two studies. Patients with symptomatic ≥ 50% carotid stenoses were included. Outcome was preoperative recurrent ipsilateral ischemic stroke or retinal artery occlusion within 28 days of presenting event. We analyzed several artery diameters on computed tomography angiography and stenosis velocity on ultrasound.
A total of 430 patients with symptomatic ≥ 50% carotid stenosis were included, 27% had near-occlusion. By traditional definition, 27% with full collapse and 11% without full collapse reached the outcome (p = 0.047). Distal internal carotid artery (ICA) diameter, ICA ratio, and ICA-to-external carotid artery ratio were associated with the outcome. Best new definition of full collapse was distal ICA diameter ≤ 2.0 mm and/or ICA ratio ≤ 0.42. With this new definition, 36% with full collapse and 4% without full collapse reached the outcome (p < 0.001).
Defining near-occlusion with full collapse as distal ICA diameter ≤ 2.0 mm and/or ICA ratio ≤ 0.42 seems to yield better prognostic discrimination than the traditional appearance-based definition. This novel definition can be used in prognostic and treatment studies of near-occlusion with full collapse.
用完全塌陷来定义新的近闭塞，以预测复发性中风。
对两项研究进行汇总分析。纳入有症状的 ≥ 50%颈动脉狭窄的患者。结局为术前同侧缺血性中风或视网膜动脉阻塞复发，发生在发病事件后 28 天内。我们分析了计算机断层血管造影上的几个动脉直径和超声上的狭窄速度。
共纳入 430 例有症状的 ≥ 50%颈动脉狭窄患者，27%存在近闭塞。按传统定义，27%完全塌陷和 11%不完全塌陷达到结局（p = 0.047）。远端颈内动脉（ICA）直径、ICA 比值和 ICA 与颈外动脉比值与结局相关。完全塌陷的最佳新定义是远端 ICA 直径 ≤ 2.0 毫米和/或 ICA 比值 ≤ 0.42。采用这一新定义，36%完全塌陷和 4%不完全塌陷达到结局（p < 0.001）。
用完全塌陷的远端 ICA 直径 ≤ 2.0 毫米和/或 ICA 比值 ≤ 0.42 来定义近闭塞似乎比传统的基于外观的定义能更好地预测预后。这种新的定义可用于完全塌陷的近闭塞的预后和治疗研究。
