Holswilder Ghislaine, Stuart Maaike Pme, Dompeling Tine, Kruyt Nyika D, Goeman Jelle J, van der Lugt Aad, Schonewille Wouter J, Lycklama À Nijeholt Geert J, Majoie Charles Blm, Yo Lonneke Sf, Meijer Frederick Ja, Marquering Henk A, Wermer Marieke Jh, van Walderveen Marianne Aa
Department of Radiology, Leiden University Medical Center, Leiden, Netherlands.
Department of Neurology, Leiden University Medical Center, Leiden, Netherlands.
Eur Stroke J. 2022 Mar;7(1):48-56. doi: 10.1177/23969873211067662. Epub 2022 Feb 8.
Vascular anatomy might affect endovascular treatment success in acute ischemic stroke patients with large vessel occlusion. We investigated the prognostic value of extracranial vascular characteristics on procedural time and revascularization success in patients with large vessel occlusion in the anterior cerebral circulation.
We included 828 patients endovascularly treated within 6.5 hours of symptom onset from the Dutch MR CLEAN-Registry. We evaluated aortic arch configuration, stenosis and tortuosity of supra-aortic arteries, and internal carotid arteries (ICAs) on pre-intervention CTA. We constructed logistic prediction models for outcome variables procedural duration (≥60 minutes) and non-successful revascularization (extended thrombolysis in cerebral infarction (eTICI) of 0-2A) using baseline characteristics and assessed the effect of extracranial vascular characteristics on model performance.
Cervical ICA tortuosity and stenosis ≥99% improved prediction of long procedural duration compared with baseline characteristics from area under the curve of 0.61 (95% CI: 0.57-0.65) to 0.66 (95% CI: 0.62-0.70) ( < 0.001). Cervical ICA tortuosity was significantly associated with non-successful recanalization. Prediction of non-successful revascularization did not improve after including aortic arch elongation, acute take-off angle, aortic variant, origin stenosis of supra-aortic arteries, and cervical ICA tortuosity, with an area under the curve of 0.63 (95% CI: 0.59-0.67) compared with 0.59 (95% CI: 0.55-0.63) ( = 0.11).
Extracranial vascular characteristics have additional prognostic value for procedural duration, but not for revascularization success, compared with baseline characteristics. Performance of both prediction models is limited in patients treated for large vessel occlusion.
血管解剖结构可能会影响急性缺血性卒中伴大血管闭塞患者血管内治疗的成功率。我们研究了颅外血管特征对大脑前循环大血管闭塞患者手术时间和血管再通成功率的预后价值。
我们纳入了荷兰MR CLEAN注册研究中症状发作6.5小时内接受血管内治疗的828例患者。我们在干预前的CTA上评估了主动脉弓形态、主动脉弓上动脉和颈内动脉（ICA）的狭窄及迂曲情况。我们使用基线特征构建了手术持续时间（≥60分钟）和血管再通失败（脑梗死扩展溶栓（eTICI）分级为0 - 2A）等结局变量的逻辑预测模型，并评估颅外血管特征对模型性能的影响。
与基线特征相比，颈段ICA迂曲和狭窄≥99%可改善对长手术持续时间的预测，曲线下面积从0.61（95%CI：0.57 - 0.65）提高到0.66（95%CI：0.62 - 0.70）（P<0.001）。颈段ICA迂曲与血管再通失败显著相关。纳入主动脉弓延长、急性起始角度、主动脉变异、主动脉弓上动脉起始部狭窄和颈段ICA迂曲后，血管再通失败的预测并未改善，曲线下面积为0.63（95%CI：0.59 - 0.67），而之前为0.59（95%CI：0.55 - 0.63）（P = 0.11）。
与基线特征相比，颅外血管特征对手术持续时间具有额外的预后价值，但对血管再通成功率没有。在接受大血管闭塞治疗的患者中，两种预测模型的性能均有限。
