Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, China.
Department of Neurology, the Third People's Hospital of Hubei Province, Jianghan University, Wuhan, China.
Clin Neurol Neurosurg. 2022 Aug;219:107315. doi: 10.1016/j.clineuro.2022.107315. Epub 2022 Jun 3.
Identification of acute internal carotid artery embolism (ICAE) and internal carotid artery atherosclerotic stenosis (ICAAS) in acute ischemic stroke patients is important for selection of treatment. The presence of contrast agent retention on pre-procedural angiographic images is more common in patients with ICA occlusion caused by embolism compared to patients with ICA atherosclerotic stenosis. This study aimed to evaluate effectiveness of contrast agent retention sign for predicting ICAE.
Sixty-five patients with ICA occlusion who underwent emergency endovascular treatment from September 2014 to September 2020 were included in this retrospective analysis. Patients were divided into ICAE (n = 46) and ICAAS (n = 19) groups. Clinical characteristics, imaging data and ICA contrast agent retention signs of patients were collected. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnosis accuracy of contrast agent retention sign were conducted.
The positive ICA contrast agent retention sign was significantly more common in patients with ICAE (60.87% vs 0.00%, P < 0.001) than that of patients with ICAAS, but significantly lower in male patients (53.57% vs 81.08%, P = 0.017). There were significantly more patients with positive sign had occlusion in C6 segment (64.29% vs 13.51%, P < 0.001) and no outflow tract (85.71% vs 5.41%, P < 0.001) compared with negative sign group. There were significantly fewer patients with postive sign had occlusion in C1 segment (0.00% vs 40.54%, P < 0.001) compared with negative sign group. The sensitivity, specificity, PPV, NPV and diagnosis accuracy of contrast agent retention sign for predicting ICAE occlusion were 60.87%, 100%, 100%, 51.35% and 72.31%, respectively.
The ICA contrast agent retention sign has very high specificity and moderate sensitivity for detection of acute ICAE.
在急性缺血性脑卒中患者中，识别急性颈内动脉栓塞（ICAE）和颈内动脉粥样硬化性狭窄（ICAAS）对于治疗选择很重要。与颈内动脉粥样硬化性狭窄患者相比，由栓塞引起的颈内动脉闭塞患者的术前血管造影图像上更常见对比剂滞留。本研究旨在评估对比剂滞留征预测 ICAE 的有效性。
回顾性分析 2014 年 9 月至 2020 年 9 月接受紧急血管内治疗的 65 例颈内动脉闭塞患者。将患者分为 ICAE（n=46）和 ICAAS（n=19）组。收集患者的临床特征、影像学资料和颈内动脉对比剂滞留征象。分析对比剂滞留征象的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和诊断准确率。
ICAE 患者的颈内动脉阳性对比剂滞留征象明显更为常见（60.87%比 0.00%，P<0.001），而男性患者明显较少（53.57%比 81.08%，P=0.017）。阳性征象组颈内动脉 C6 段闭塞患者明显更多（64.29%比 13.51%，P<0.001），无流出道（85.71%比 5.41%，P<0.001），而阴性征象组明显较少。阳性征象组颈内动脉 C1 段闭塞患者明显较少（0.00%比 40.54%，P<0.001）。颈内动脉对比剂滞留征象预测 ICAE 闭塞的敏感性、特异性、PPV、NPV 和诊断准确率分别为 60.87%、100%、100%、51.35%和 72.31%。
颈内动脉对比剂滞留征象对急性 ICAE 的检测具有很高的特异性和中等的敏感性。
