Department of Radiology, Wuxi Second People's Hospital, Wuxi, China.
Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
World Neurosurg. 2022 Nov;167:e1138-e1146. doi: 10.1016/j.wneu.2022.08.137. Epub 2022 Sep 8.
Endovascular mechanical thrombectomy (EVMT) has shown significant efficacy in improving neurological functions in patients with intracranial internal carotid artery occlusion (IICAO), but its clinical outcomes are variable. We examined the relationship between favorable clinical outcomes after EVMT in IICAO and a set of predictors.
In this retrospective study, 189 patients with IICAO treated by EVMT at 3 centers from November 2015 to December 2020 were included and analyzed. Non-contrast computed tomography and computed tomography angiography were evaluated on admission. The morphology of IICAO was categorized into Ia, Ib, L, or T types, depending on the involvement of the posterior communicating artery origin, proximal anterior cerebral artery, and middle cerebral artery. The Willis' circle was categorized as integrated or compromised Willis' circle. In combination with the involvement of the IICAO and the integrity of Willis' circle, we used the primary collateral grade (PCG) to describe the presence of functional Willisian collaterals. Baseline data including demographics, characteristics, vascular risk factors, and initial National Institutes of Health Stroke Scale scores were collected. Hemorrhagic transformation was evaluated using the 24-hour non-contrast computed tomography after EVMT. Favorable outcomes based on modified Rankin scale, were defined as 0-2 at 90 days.
A total of 189 patients were included (median age, 69 years; 126 male [66.7%]). 104 patients [55.0%] showed reperfusion after EVMT, but 72 patients [38.1%] achieved favorable outcomes at 90 days. The mortality rate of type Ib was significantly higher than that with type Ia (χ = 14.21, P = 0.001). The outcome with different structure of Willis' circle was not statistically different between the 2 groups. A multivariate logistic regression analysis showed that IICAO T-type (odds ratio, 0.028 [95% confidence interval: 0.323-3.829], P = 0.042) and PCG 2 (odds ratio 9.427[95% confidence interval:1.863-47.698], P = 0.007) were predictors of favorable outcomes.
Evaluation of PCG by determining the type of IICAO and the integrity of Willis' circle may serve as a valuable indicator for the prognosis and as an essential reference for screening patients before EVMT.
血管内机械血栓切除术（EVMT）已显示出在改善颅内颈内动脉闭塞（IICAO）患者的神经功能方面具有显著疗效，但临床结果存在差异。我们研究了 EVMT 后 IICAO 患者的良好临床结果与一系列预测因素之间的关系。
在这项回顾性研究中，纳入了 2015 年 11 月至 2020 年 12 月在 3 个中心接受 EVMT 治疗的 189 例 IICAO 患者，并对其进行了分析。入院时进行非对比计算机断层扫描和计算机断层血管造影检查。根据后交通动脉起源、大脑前动脉近端和大脑中动脉受累情况，将 IICAO 的形态分为 Ia、Ib、L 或 T 型。Willis 环分为完整或受损 Willis 环。结合 IICAO 的受累情况和 Willis 环的完整性，我们使用主要侧支分级（PCG）来描述功能性 Willis 侧支的存在情况。收集了包括人口统计学、特征、血管危险因素和初始国立卫生研究院卒中量表评分在内的基线数据。EVMT 后 24 小时行非对比计算机断层扫描评估出血转化。基于改良 Rankin 量表的良好结局定义为 90 天时 0-2 分。
共纳入 189 例患者（中位年龄 69 岁，126 例男性[66.7%]）。104 例患者（55.0%）在 EVMT 后出现再灌注，但 72 例患者（38.1%）在 90 天时获得了良好结局。Ib 型的死亡率明显高于 Ia 型（χ²=14.21，P=0.001）。2 组 Willis 环不同结构的结局无统计学差异。多因素逻辑回归分析显示，IICAO T 型（比值比，0.028[95%置信区间：0.323-3.829]，P=0.042）和 PCG 2 型（比值比，9.427[95%置信区间：1.863-47.698]，P=0.007）是良好结局的预测因素。
通过确定 IICAO 类型和 Willis 环的完整性来评估 PCG 可能成为预后的有价值指标，并为 EVMT 前筛选患者提供重要参考。
