Hou Zhikai, Yan Long, Zhang Zhe, Jing Jing, Lyu Jinhao, Hui Ferdinand K, Fu Weilun, Yu Ying, Cui Rongrong, Wan Min, Song Jia, Wang Yongjun, Miao Zhongrong, Lou Xin, Ma Ning
1Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
2China National Clinical Research Center for Neurological Diseases, Beijing, China.
J Neurosurg. 2021 Dec 3;137(2):412-418. doi: 10.3171/2021.9.JNS211770. Print 2022 Aug 1.
On the basis of the characteristics of occluded segments on high-resolution magnetic resonance vessel wall imaging (MR-VWI), the authors evaluated the role of high-resolution MR-VWI-guided endovascular recanalization for patients with symptomatic nonacute intracranial artery occlusion (ICAO).
Consecutive patients with symptomatic nonacute ICAO that was refractory to aggressive medical treatment were prospectively enrolled and underwent endovascular recanalization. High-resolution MR-VWI was performed before the recanalization intervention. The characteristics of the occluded segments on MR-VWI, including signal intensity, occlusion morphology, occlusion angle, and occlusion length, were evaluated. Technical success was defined as arterial recanalization with modified Thrombolysis in Cerebral Infarction grade 2b or 3 and residual stenosis < 50%. Perioperative complications were recorded. The characteristics of the occluded segments on MR-VWI were compared between the recanalized group and the failure group.
Twenty-five patients with symptomatic nonacute ICAO that was refractory to aggressive medical treatment were consecutively enrolled from April 2020 to February 2021. Technical success was achieved in 19 patients (76.0%). One patient (4.0%) had a nondisabling ischemic stroke during the perioperative period. Multivariable logistic analysis showed that successful recanalization of nonacute ICAO was associated with occlusion with residual lumen (OR 0.057, 95% CI 0.004-0.735, p = 0.028) and shorter occlusion length (OR 0.853, 95% CI 0.737-0.989, p = 0.035).
The high-resolution MR-VWI modality could be used to guide endovascular recanalization for nonacute ICAO. Occlusion with residual lumen and shorter occlusion length on high-resolution MR-VWI were identified as predictors of technical success of endovascular recanalization for nonacute ICAO.
基于高分辨率磁共振血管壁成像（MR-VWI）上闭塞节段的特征，作者评估了高分辨率MR-VWI引导下血管内再通术对有症状的非急性颅内动脉闭塞（ICAO）患者的作用。
前瞻性纳入连续的经积极药物治疗无效的有症状非急性ICAO患者，并接受血管内再通术。在再通干预前进行高分辨率MR-VWI检查。评估MR-VWI上闭塞节段的特征，包括信号强度、闭塞形态、闭塞角度和闭塞长度。技术成功定义为动脉再通，改良脑梗死溶栓分级为2b或3级，残余狭窄<50%。记录围手术期并发症。比较再通组和失败组MR-VWI上闭塞节段的特征。
2020年4月至2021年2月连续纳入25例经积极药物治疗无效的有症状非急性ICAO患者。19例（76.0%）获得技术成功。1例患者（4.0%）在围手术期发生非致残性缺血性卒中。多变量逻辑分析显示，非急性ICAO成功再通与残留管腔闭塞（OR 0.057，95%CI 0.004-0.735，p = 0.028）和较短的闭塞长度（OR 0.853，95%CI 0.737-0.989，p = 0.035）相关。
高分辨率MR-VWI模式可用于指导非急性ICAO的血管内再通术。高分辨率MR-VWI上残留管腔闭塞和较短的闭塞长度被确定为非急性ICAO血管内再通术技术成功的预测因素。
