Chao Liu, Qingbin Meng, Haowen Xu, Shanshan Xie, Qichang Fu, Zhen Chen, Sheng Guan
Department of Interventional Neuroradiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Front Neurol. 2021 Oct 26;12:692128. doi: 10.3389/fneur.2021.692128. eCollection 2021.
To investigate the predictive factors for successful recanalization based on digital subtraction angiography and three-dimensional T1W sampling perfection with application-optimized contrasts using different flip angle evolutions (3D T1-SPACE) high-resolution magnetic resonance imaging (MRI) signal features. Consecutive internal carotid artery occlusion cases with ipsilateral ischemic stroke refractory to therapy who visited our institution between February 2017 and August 2020 were retrospectively analyzed. Epidemiology, symptomatology, imaging morphology on angiography and MRI, peri-procedural complications, technical success rate, and follow-up results were summarized. Factors related to technical success were analyzed using univariate and multivariate analyses. In total, 75 cases (53 men, mean age 57.51 ± 9.71 years) were included. The total successful recanalization rate was 72.00% (54/75), with a complication rate of 13.33% (9/75). Through multivariate analysis, first ischemic stroke in <3 months (OR: 2.57; 95% CI: 1.13-4.58), tapered stump (OR: 4.31; 95% CI: 1.37-13.55), reversed flow of the ophthalmic artery (OR: 2.99; 95% CI: 1.06-8.49), high intraluminal signal on unenhanced T1-SPACE sequence (OR: 16.15; 95% CI: 3.40-76.72), no vessel wall collapse (OR: 17.00; 95% CI: 3.57-81.02), short occlusion length (OR: 9.87; 95% CI: 2.09-46.64), and primary occlusion site at the cervical internal carotid artery (OR: 8.42; 95% CI: 1.04-68.19) were associated with successful recanalization. Besides traditional features such as short ischemic event time, tapered stump, and distal ICA reconstitution by the ophthalmic artery, our study demonstrates that luminal and mural changes determined by 3D SPACE high-resolution MRI could also predict successful endovascular recanalization. Endovascular recanalization for non-acute internal carotid artery occlusion is feasible, but prudent case selection is mandatory considering the high periprocedural complication rate.
基于数字减影血管造影和三维T1加权采样完美应用优化对比剂不同翻转角演化序列（3D T1-SPACE）高分辨率磁共振成像（MRI）信号特征，探讨成功再通的预测因素。回顾性分析2017年2月至2020年8月期间在我院就诊的同侧缺血性卒中经治疗无效的连续性颈内动脉闭塞病例。总结其流行病学、症状学、血管造影和MRI的影像形态学、围手术期并发症、技术成功率及随访结果。采用单因素和多因素分析技术成功的相关因素。共纳入75例（男性53例，平均年龄57.51±9.71岁）。总成功再通率为72.00%（54/75），并发症发生率为13.33%（9/75）。多因素分析显示，发病<3个月的首次缺血性卒中（OR：2.57；95%CI：1.13 - 4.58）、残端呈锥形（OR：4.31；95%CI：1.37 - 13.55）、眼动脉逆流（OR：2.99；95%CI：1.06 - 8.49）、未增强T1-SPACE序列上管腔内高信号（OR：16.15；95%CI：3.40 - 76.72）、无血管壁塌陷（OR：17.00；95%CI：3.57 - 81.02）、闭塞长度短（OR：9.87；95%CI：2.09 - 46.64）以及颈内动脉颈段为原发闭塞部位（OR：8.42；95%CI：1.04 - 68.19）与成功再通相关。除了缺血事件时间短、残端呈锥形以及眼动脉对颈内动脉远端重建等传统特征外，我们的研究表明，3D SPACE高分辨率MRI所确定的管腔和管壁变化也可预测血管内再通成功。非急性颈内动脉闭塞的血管内再通是可行的，但考虑到围手术期并发症发生率高，必须谨慎选择病例。
