Department of Neurointervention, Zhangzhou Affiliated Hospital of Fujian Medical University, China (T.Y., X.L., Y.W., D.L., Z.P., X.Z., G.H., M.W., L.Z., W.C.).
Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China (T.Y.).
Stroke. 2024 Apr;55(4):1025-1031. doi: 10.1161/STROKEAHA.123.045156. Epub 2024 Mar 25.
To differentiate between pseudo occlusion (PO) and true occlusion (TO) of internal carotid artery (ICA) is important in thrombectomy treatment planning for patients with acute ischemic stroke. Although delayed contrast filling has been differentiated carotid PO from TO, its application has been limited by the implementations of multiphasic computed tomography angiography. In this study, we hypothesized that carotid ring sign, which is readily acquired from single-phasic CTA, can sufficiently differentiate carotid TO from PO.
One thousand four hundred and twenty patients with anterior circulation stroke receiving endovascular therapy were consecutively recruited through a hospital- and web-based registry. Two hundred patients with nonvisualization of the proximal ICA were included in the analysis after a retrospective screening. Diagnosis of PO or TO of the cervical segment of ICA was made based on digital subtraction angiography. Diagnostic performances of carotid ring sign on arterial-phasic CTA and delayed contrast filling on multiphasic computed tomography angiography were evaluated and compared.
One-hundred twelve patients had ICA PO and 88 had TO. Carotid ring sign was more common in patients with TO (70.5% versus 6.3%; <0.001), whereas delayed contrast filling was more common in PO (94.9% versus 7.7%; <0.001). The sensitivity and specificity of carotid ring sign in diagnosing carotid TO were 0.70 and 0.94, respectively, whereas sensitivity and specificity of delayed contrast filling was 0.95 and 0.92 in judging carotid PO.
Carotid ring sign is a potent imaging marker in diagnosing ICA TO. Carotid ring sign could be complementary to delayed contrast filling sign in differentiating TO from PO, in particular in centers with only single-phasic CTA.
在急性缺血性脑卒中患者的血栓切除术治疗计划中，区分颈内动脉（ICA）的假性闭塞（PO）和真性闭塞（TO）非常重要。虽然延迟对比填充已经可以区分颈动脉 PO 和 TO，但由于多相 CT 血管造影的实施，其应用受到限制。在这项研究中，我们假设颈动脉环征可以从单相 CTA 中获得，足以充分区分颈动脉 TO 和 PO。
通过医院和网络注册，连续招募了 1420 名接受血管内治疗的前循环卒中患者。在回顾性筛选后，纳入了 200 名近端 ICA 不可见的患者进行分析。根据数字减影血管造影（DSA）诊断颈段 ICA 的 PO 或 TO。评估并比较了颈动脉环征在动脉相 CTA 和多相 CT 血管造影上的延迟对比填充在诊断中的表现。
112 例患者 ICA 为 PO，88 例为 TO。TO 患者颈动脉环征更为常见（70.5%比 6.3%；<0.001），而 PO 患者延迟对比填充更为常见（94.9%比 7.7%；<0.001）。颈动脉环征诊断颈动脉 TO 的敏感性和特异性分别为 0.70 和 0.94，而延迟对比填充在判断颈动脉 PO 时的敏感性和特异性分别为 0.95 和 0.92。
颈动脉环征是诊断 ICA TO 的有力影像学标志物。颈动脉环征可以与延迟对比填充相补充，以区分 TO 和 PO，特别是在只有单相 CTA 的中心。
