Li Jichuan, Yang Jianhong, Gao Xiang, Han Qing, Wu Yuefei, Shang Qing, Huang Yueshi, Xu Yao, Huang Yi, Lin Longting
Department of Neurology, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China.
Department of Neurology, The First People's Hospital of Yuexi County, Liangshan, China.
Front Neurol. 2024 Jul 24;15:1395764. doi: 10.3389/fneur.2024.1395764. eCollection 2024.
This study examines whether clot patterns at large artery occlusion sites, as observed using digital subtraction angiography (DSA) and computed tomography angiography (CTA), can reliably indicate intracranial atherosclerotic stenosis (ICAS) in acute ischemic stroke (AIS) patients.
We conducted a retrospective analysis of patients treated with stent retriever thrombectomy for intracranial occlusions at our institute since 2017, with follow-up assessments conducted at 3 months. The patients were grouped based on the initial angiography clot topographies (i.e., cut-off or tapered signs). We assessed the potential of these topographies in predicting ICAS, including a clinical outcome analysis based on clot pattern, age, Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification, and onset-to-door time.
Among 131 patients (with a mean age of 66.6 years), the clot pattern emerged as a significant predictor of ICAS. The DSA-based model had a predictive area under the curve (AUC) of 0.745, with 55.1% sensitivity and 94.0% specificity. A multivariate model including age, onset-to-door time, TOAST classification as large artery atherosclerosis (LAA), and the presence of the tapered sign in clot patterns had an AUC of 0.916. In patients over 65 years of age with an onset-to-door time of >5 h and exhibiting a tapered sign in the clot pattern, the AUC reached 0.897. The predictive ability of the tapered sign was similar in DSA and CTA, showing 73.4% agreement between modalities.
The clot pattern with the tapered sign as observed using DSA is significantly associated with ICAS. Incorporating this clot pattern with age, TOAST classification as LAA, and onset-to-door time enhances the prediction of ICAS. The clot pattern identified by CTA is also a reliable predictor, highlighting the importance of assessing clot patterns in ICAS identification.
本研究旨在探讨使用数字减影血管造影（DSA）和计算机断层血管造影（CTA）观察到的大动脉闭塞部位的血栓形态，能否可靠地指示急性缺血性卒中（AIS）患者的颅内动脉粥样硬化狭窄（ICAS）。
我们对2017年以来在我院接受支架取栓治疗颅内闭塞的患者进行了回顾性分析，并在3个月时进行随访评估。根据初始血管造影的血栓形态（即截断或锥形征）对患者进行分组。我们评估了这些形态在预测ICAS方面的潜力，包括基于血栓形态、年龄、急性卒中治疗中组织纤溶酶原激活剂-10172试验（TOAST）分类和发病至入院时间的临床结局分析。
在131例患者（平均年龄66.6岁）中，血栓形态成为ICAS的重要预测指标。基于DSA的模型曲线下面积（AUC）为0.745，敏感性为55.1%，特异性为94.0%。一个包括年龄、发病至入院时间、TOAST分类为大动脉粥样硬化（LAA）以及血栓形态中存在锥形征的多变量模型的AUC为0.916。在年龄超过65岁、发病至入院时间>5小时且血栓形态显示锥形征的患者中，AUC达到0.897。DSA和CTA中锥形征的预测能力相似，两种检查方式之间的一致性为73.4%。
DSA观察到的具有锥形征的血栓形态与ICAS显著相关。将这种血栓形态与年龄、TOAST分类为LAA以及发病至入院时间相结合，可提高ICAS的预测能力。CTA识别的血栓形态也是一个可靠的预测指标，突出了在ICAS识别中评估血栓形态的重要性。
