Wang Junjie, Zhang Shun, Lu Jun, Qi Peng, Hu Shen, Yang Ximeng, Chen Kunpeng, Wang Daming
Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.
Graduate School of Peking Union Medical College, Beijing, China.
Front Neurol. 2021 Dec 24;12:706645. doi: 10.3389/fneur.2021.706645. eCollection 2021.
An endovascular recanalization is an alternative option for symptomatic intracranial atherosclerotic steno-occlusive disease (ICAD). Accurate non-invasive alternatives to digital subtraction angiography (DSA) for follow-up imaging after endovascular treatment are desirable. We aimed to evaluate the image quality and diagnostic performance of high-resolution magnetic imaging in follow-up using DSA as a reference. From January 2017 to June 2021, data from 35 patients with 40 intracranial steno-occlusive lesions who underwent endovascular recanalization and received high-resolution magnetic resonance (HR-MR) follow-up were retrospectively collected in our prospective database. Studies were evaluated for the quality of visualization of the vessel lumen, restenosis rate, and accuracy of high-resolution magnetic resonance (HR-MR) with DSA used as the reference standard. Intraclass correlation coefficient (ICC) analyses were performed to assess the agreement between the two different readers. In total, 40 intracranial steno-occlusive lesions in 35 patients, with 34 lesions undergoing balloon angioplasty [including 16 drug-coated balloons (DCBs)] and 8 lesions undergoing stenting were enrolled. The median age was 63.6 years (IQR 58.5-70.0 years), and the mean imaging follow-up time was 9.5 months (IQR 4.8-12.5 months). The median degrees of preprocedural and residual stenosis were 85.0% (IQR 75.0-99.0%) and 32.8% (IQR 15.0-50.0%), respectively. Intracranial periprocedural complications occurred in 1 (3.6%) patient. In the case of a stainless-steel stent ( = 1), there was a signal drop at the level of the vessel, which did not allow evaluation of the vessel lumen. However, this was visible in the case of nitinol stents ( = 7) and angioplasty ( = 34). The overall restenosis rate was 25.8% ( = 9). The DCB subgroup showed a lower rate of restenosis than the percutaneous transluminal angioplasty (PTA) subgroup [5.3% (2/13) vs. 35.7% (5/14)]. High-resolution magnetic resonance may be a reliable non-invasive method for demonstrating the vessel lumen and diagnostic follow-up after endovascular recanalization for ICAD. Compared with MR angiography (MRA), HR-MR showed a higher inter-reader agreement and could provide more information after endovascular recanalization, such as enhancement of the vessel wall.
血管内再通术是有症状的颅内动脉粥样硬化性狭窄闭塞性疾病（ICAD）的一种替代选择。对于血管内治疗后的随访成像，需要有准确的数字减影血管造影（DSA）的非侵入性替代方法。我们旨在以DSA为参考，评估高分辨率磁共振成像在随访中的图像质量和诊断性能。2017年1月至2021年6月，我们前瞻性数据库中回顾性收集了35例患有40处颅内狭窄闭塞性病变且接受了血管内再通术并进行高分辨率磁共振（HR-MR）随访的患者的数据。以DSA作为参考标准，对研究的血管腔可视化质量、再狭窄率和高分辨率磁共振（HR-MR）的准确性进行评估。进行组内相关系数（ICC）分析以评估两位不同阅片者之间的一致性。总共纳入了35例患者的40处颅内狭窄闭塞性病变，其中34处病变接受了球囊血管成形术[包括16处药物洗脱球囊（DCB）]，8处病变接受了支架置入术。中位年龄为63.6岁（四分位间距58.5 - 70.0岁），平均影像随访时间为9.5个月（四分位间距4.8 - 12.5个月）。术前和残余狭窄的中位程度分别为85.0%（四分位间距75.0 - 99.0%）和32.8%（四分位间距15.0 - 50.0%）。1例（3.6%）患者发生颅内围手术期并发症。对于不锈钢支架（n = 1），在血管水平出现信号下降，无法评估血管腔。然而，在镍钛合金支架（n = 7）和血管成形术（n = 34）的情况下可见血管腔。总体再狭窄率为25.8%（n = 9）。DCB亚组的再狭窄率低于经皮腔内血管成形术（PTA）亚组[5.3%（2/13）对35.7%（5/14）]。高分辨率磁共振可能是一种可靠的非侵入性方法，用于显示ICAD血管内再通术后的血管腔并进行诊断随访。与磁共振血管造影（MRA）相比，HR-MR显示出更高的阅片者间一致性，并且在血管内再通术后可以提供更多信息，如血管壁强化。
