From the Departments of MRI (M.T., X.Y., J.G., L.L., X. Zhe., X. Zhang., N.M., X. Zhang).
Neurology (F.J., J.H.), Shaanxi Provincial People's Hospital, Beilin District, Xi'an City, Shaanxi Province, China.
AJNR Am J Neuroradiol. 2022 Aug;43(8):1164-1171. doi: 10.3174/ajnr.A7576. Epub 2022 Jul 21.
Accurate radiologic evaluation of the possibility of successful recanalization in symptomatic chronic ICA occlusion remains challenging. This study aimed to investigate the high-resolution MR imaging characteristics of symptomatic chronic ICA occlusion and their association with successful recanalization.
Consecutive patients with symptomatic chronic ICA occlusion who underwent balloon dilation plus stent implantation were identified retrospectively and divided into 2 groups: a successful recanalization group and an unsuccessful recanalization group. Clinical and high-resolution MR imaging characteristics were compared between the groups. Univariate and multivariate analyses were used to identify the characteristics associated with successful recanalization.
A total of 114 patients were included in the study. High-resolution MR imaging characteristics independently associated with unsuccessful recanalization were longer lesion length (OR, 0.41; 95% CI, 0.36-0.55; = .009) and larger calcification volume (OR, 0.56; 95% CI, 0.37-0.68; = .002) for proximal occlusion and reversed distal ICA flow at the level of ophthalmic segment or above (OR, 0.14; 95% CI, 0.08-0.48; = .001). Reversed distal ICA flow at the level of the petrous segment or below (OR, 4.07; 95% CI, 1.65-8.38; = .001) and lumen area (OR, 1.13; 95% CI, 1.04-1.61; = .002) for distal occlusion were risk factors of successful recanalization.
In symptomatic chronic ICA occlusion, lesion length and calcification volume (for proximal occlusion), the level of reversed distal ICA flow, and the lumen area (for distal occlusion) appear to be predictors of successful recanalization. High-resolution MR imaging can evaluate chronic ICA occlusion and help in clinical decision-making.
准确评估症状性慢性颈内动脉闭塞再通的可能性仍然具有挑战性。本研究旨在探讨症状性慢性颈内动脉闭塞的高分辨率磁共振成像特征及其与再通成功的关系。
回顾性分析了连续接受球囊扩张加支架植入术治疗的症状性慢性颈内动脉闭塞患者，分为再通成功组和再通失败组。比较两组的临床和高分辨率磁共振成像特征。采用单因素和多因素分析确定与再通成功相关的特征。
共纳入 114 例患者。近端闭塞与再通失败独立相关的高分辨率磁共振成像特征为病变长度较长（比值比，0.41；95%置信区间，0.36-0.55；P =.009）和较大的钙化体积（比值比，0.56；95%置信区间，0.37-0.68；P =.002）；眼段或以上水平的反向颈内动脉血流（比值比，0.14；95%置信区间，0.08-0.48；P =.001）。岩骨段或以下水平的反向颈内动脉血流（比值比，4.07；95%置信区间，1.65-8.38；P =.001）和管腔面积（比值比，1.13；95%置信区间，1.04-1.61；P =.002）是再通成功的危险因素。
在症状性慢性颈内动脉闭塞中，病变长度和钙化体积（近端闭塞）、反向颈内动脉血流水平和管腔面积（远端闭塞）似乎是再通成功的预测因素。高分辨率磁共振成像可以评估慢性颈内动脉闭塞，并有助于临床决策。
