Ha Sang Woo, Lee Chan-Hyuk, Kim Hak Sung, Yeon Eung Koo, Lee Seung Jae, Shin Byoung-Soo, Kang Hyun Goo
Department of Neurosurgery, Chosun University Medical School, Gwangju 61453, Korea.
Department of Neurology, Jeonbuk National University Hospital, Jeonju 54907, Korea.
Diagnostics (Basel). 2022 Feb 14;12(2):494. doi: 10.3390/diagnostics12020494.
Acute internal carotid artery (ICA) occlusions cause extensive brain ischemia. Accurate determination of the occlusion site facilitates rapid revascularization interventions and improves prognosis. However, proximal ICA occlusions, as determined with computed tomography (CT) angiography, often are located more distally. Therefore, we assessed clinical and imaging factors associated with the accurate determination of occlusion sites. In this observational study, we evaluated 102 patients who presented acute ischemic stroke symptoms and had a CT angiography within 6 h, showing proximal ICA occlusion. The participants were divided into two groups, depending on whether there was correspondence between digital subtraction angiography and CT angiography regarding the occlusion location. Proximal occlusions were, accordingly, categorized as "true" (correspondence) or "false" (no correspondence; distal). Demographic, clinical, and imaging features were analyzed. Multivariate regression analysis was performed to identify factors predicting the correspondence between actual ICA occlusion sites and those detected by CT angiography. The shape (Odds ratios, OR = 646.584; Confidence interval, CI = 21.703-19263.187; < 0.001) and the length (OR = 0.696; CI = 0.535-0.904; = 0.007) of the ICA occlusion and atrial fibrillation (OR = 0.024; CI = 0.002-0.340; = 0.006) were significant factors. The cut-off length of ICA stump at 6.2 mm, the sensitivity was 71%, and the specificity was 70% (area under the ROC curve = 0.767).
急性颈内动脉（ICA）闭塞可导致广泛的脑缺血。准确确定闭塞部位有助于快速进行血管再通干预并改善预后。然而，通过计算机断层扫描（CT）血管造影确定的ICA近端闭塞往往位于更靠远端的位置。因此，我们评估了与准确确定闭塞部位相关的临床和影像学因素。在这项观察性研究中，我们评估了102例出现急性缺血性卒中症状且在6小时内进行了CT血管造影显示ICA近端闭塞的患者。根据数字减影血管造影和CT血管造影在闭塞位置上是否一致，将参与者分为两组。相应地，近端闭塞被分类为“真”（一致）或“假”（不一致；位于远端）。分析了人口统计学、临床和影像学特征。进行多变量回归分析以确定预测实际ICA闭塞部位与CT血管造影检测部位一致性的因素。ICA闭塞的形状（比值比，OR = 646.584；置信区间，CI = 21.703 - 19263.187；P < 0.001）、长度（OR = 0.696；CI = 0.535 - 0.904；P = 0.007）以及心房颤动（OR = 0.024；CI = 0.002 - 0.340；P = 0.006）是显著因素。ICA残端长度的截断值为6.2 mm时，敏感性为71%，特异性为70%（ROC曲线下面积 = 0.767）。
