Department of Emergency and Critical Care Medicine, Kansai Medical University General Medical Center, Osaka, Japan.
Department of Neurosurgery, Nagareyama Central Hospital, Chiba, Japan.
Cerebrovasc Dis Extra. 2021;11(3):131-136. doi: 10.1159/000519556. Epub 2021 Nov 12.
The impact of the length of the occluded vessel in acute large-vessel occlusion on successful reperfusion by mechanical thrombectomy remains unclear. This study evaluated whether diameter and length of the occluded vessel in acute middle cerebral artery (MCA) occlusion might relate to successful reperfusion following mechanical thrombectomy.
This retrospective study included patients with acute MCA occlusion who underwent intra-aortic injection of contrast medium to obtain maximum intensity projection (MIP) images acquired by flat-panel detector computed tomography (FD-CT) equipped with an angiographic system. All patients received mechanical thrombectomy and were divided into two groups: those with successful reperfusion (Thrombolysis in Cerebral Infarction [TICI] 2b/3) and those without. We compared the diameter and length of the occluded vessel between the groups. In the sub-analysis of patients with stent retriever use, ratio of length of occluded vessel to length of the active zone was compared.
We enrolled 29 patients (median age: 73, M1 occlusion: 51%, stent retriever use: 72%). Eighteen patients achieved TICI 2b/3 with significantly larger distal end diameter (1.7 [interquartile range: 1.5-1.9] vs. 1.2 [1.2-1.5] mm, p = 0.007) and shorter length (7.1 [4.9-9.7] vs. 12.3 [7.2-15.8] mm, p = 0.043) of the occluded vessel. Sub-analysis of 21 patients showed that the cut-off value for TICI 2b/3 reperfusion was 0.32 as the ratio between the occluded vessel and stent retriever active zone (receiver operating characteristic area under the curve: 0.90).
In acute MCA occlusion, larger diameter of the distal end and shorter length of the occluded vessel on FD-CT MIP images might indicate a higher possibility of achieving TICI 2b/3 following mechanical thrombectomy.
机械取栓后血管再通与急性大血管闭塞（LVO）中闭塞血管长度的关系仍不清楚。本研究评估了急性大脑中动脉（MCA）闭塞患者中闭塞血管的直径和长度与机械取栓后再通的关系。
本回顾性研究纳入了接受主动脉内注射造影剂以获取配备血管造影系统的平板探测器 CT（FD-CT）获得最大强度投影（MIP）图像的急性 MCA 闭塞患者。所有患者均接受机械取栓，并分为再通成功（血栓切除术溶栓分级[TICI]2b/3）和再通失败两组。我们比较了两组患者的闭塞血管直径和长度。在使用支架取栓器的患者亚分析中，比较了闭塞血管长度与活性区长度的比值。
共纳入 29 例患者（中位年龄 73 岁，M1 段闭塞 51%，使用支架取栓器 72%）。18 例患者达到 TICI 2b/3，其远端直径明显更大（1.7 [四分位距：1.5-1.9] vs. 1.2 [1.2-1.5] mm，p = 0.007），闭塞血管长度更短（7.1 [4.9-9.7] vs. 12.3 [7.2-15.8] mm，p = 0.043）。21 例患者的亚分析显示，TICI 2b/3 再通的截断值为 0.32，即闭塞血管与支架取栓器活性区的比值（受试者工作特征曲线下面积：0.90）。
在急性 MCA 闭塞中，FD-CT MIP 图像上远端直径更大和闭塞血管长度更短可能预示着机械取栓后 TICI 2b/3 再通的可能性更高。
