Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing 210029, China.
Department of Biostatistics, School of Public Health, Nanjing Medical University, 101 Longmian Avenue, Nanjing 211166, China.
Clin Neurol Neurosurg. 2023 Oct;233:107935. doi: 10.1016/j.clineuro.2023.107935. Epub 2023 Aug 7.
To stratify angiographic images of chronic internal carotid artery occlusion (CICAO) into a newly modified angiographic classification, and identify suitable candidates for endovascular recanalization.
This study included 51 consecutive patients with symptomatic CICAO who underwent endovascular recanalization at our institution. Patients' clinical information, angiographic findings, procedural results, and outcomes were recorded. We attempted to stratify all angiographic images into categories based on morphological occlusive patterns and distal internal carotid artery (ICA) lumen reconstitution on digital subtraction angiography (DSA).
Four types (I-IV) of CICAO were identified based on angiographic characteristics. We defined type I as having a tapered (IA) or blunt stump (IB) and distal ICA lumen reconstitution with collateral filling; type II as having no stump but with distal ICA lumen reconstitution; type III as having a tapered (IIIA) or blunt stump (IIIB) but no distal ICA lumen reconstitution; type IV as having no stump and no distal ICA lumen reconstitution. The rate of successful recanalization was 90.3 % for type I, 60.0 % for type II, 50.0 % for type III, 0 % for type IV, respectively (P = 0.002). The overall intraoperative complication rate was 11.8 %, and none of them led to severe neurological damage or death. The follow-up modified Rankin Scale (mRS) scores were significantly decreased in successfully revascularized patients, whilst there were no significant changes in the other failed patients.
For symptomatic CICAO, our newly modified angiographic classification may be comprehensive and useful in selecting suitable patients for recanalization and grading the difficulty of the procedures.
将慢性颈内动脉闭塞（CICAO）的血管造影图像分为新的改良血管造影分类，并确定适合血管内再通的患者。
本研究纳入了 51 例在我院接受血管内再通治疗的有症状 CICAO 患者。记录患者的临床资料、血管造影结果、手术结果和转归。我们试图根据形态闭塞模式和数字减影血管造影（DSA）上远端颈内动脉（ICA）管腔再通情况，将所有血管造影图像分为不同类别。
根据血管造影特征，确定了 4 种类型（I-IV）的 CICAO。我们将 I 型定义为有锥形（IA）或钝形残端（IB）和远端 ICA 管腔再通伴侧支充盈；II 型为无残端但有远端 ICA 管腔再通；III 型为有锥形（IIIA）或钝形残端（IIIB）但无远端 ICA 管腔再通；IV 型为无残端且无远端 ICA 管腔再通。I 型、II 型、III 型和 IV 型的再通成功率分别为 90.3%、60.0%、50.0%和 0%（P=0.002）。总的术中并发症发生率为 11.8%，均未导致严重的神经损伤或死亡。成功再通患者的随访改良 Rankin 量表（mRS）评分显著降低，而其他失败患者无明显变化。
对于有症状的 CICAO，我们新的改良血管造影分类可能是全面和有用的，可以选择适合再通的患者，并对手术难度进行分级。
