Zhou Chun, Cao Yue-Zhou, Jia Zhen-Yu, Zhao Lin-Bo, Lu Shan-Shan, Xu Xiao-Quan, Shi Hai-Bin, Liu Sheng
Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing 210029, China (C.Z., Y-Z.C., Z-Y.J., L-B.Z., H-B.S., S.L.).
Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing 210029, China (S-S.L., X-Q.X.).
Acad Radiol. 2025 Mar;32(3):1621-1630. doi: 10.1016/j.acra.2024.10.020. Epub 2024 Oct 31.
Endovascular recanalization has been attempted in patients with symptomatic chronic intracranial large artery occlusion (CILAO), however, the heterogeneity of recanalization outcomes present challenges for the clinical application.
To determine the radiological features on high-resolution MR imaging (HR-MRI) for predicting successful recanalization of symptomatic CILAO.
Seventy-three patients with symptomatic CILAO who underwent endovascular recanalization at our center were retrospectively analyzed. Patients' clinical information, HR-MRI characteristics, procedural results, and outcomes were recorded. Factors related to successful recanalization were analyzed by univariate and multivariate analyses.
Technical success was achieved in 61 (83.6%) patients, with a complication rate of 13.7% (10/73). Based on multivariate analysis, responsible occluded artery (middle cerebral artery (MCA) trunk versus intracranial internal carotid artery (ICA), P = 0.004; MCA trunk versus intracranial vertebrobasilar artery (VBA), P = 0.010), occlusion with residual lumen (P = 0.036), occlusion with marked plaque enhancement (P = 0.011), and shorter occlusion length (≤10.2 mm versus >10.2 mm, P = 0.008) were identified as independent positive predictors of successful recanalization. Patients were assigned score points according to the coefficients of the prediction model, and the technical success rates were 50.0%, 83.3%, 95.5%, and 100% in patients with score ≤ 2, 3, 4, and ≥ 5 points, respectively.
The HR-MRI modality may be valuable in identifying candidates for endovascular recanalization of symptomatic CILAO. MCA trunk occlusion, occlusion with residual lumen, occlusion with marked plaque enhancement and shorter occlusion length on HR-MRI appear to be significantly associated with the success of recanalization.
有症状的慢性颅内大动脉闭塞（CILAO）患者已尝试进行血管内再通治疗，然而，再通结果的异质性给临床应用带来了挑战。
确定高分辨率磁共振成像（HR-MRI）上用于预测有症状CILAO成功再通的影像学特征。
回顾性分析在本中心接受血管内再通治疗的73例有症状CILAO患者。记录患者的临床信息、HR-MRI特征、手术结果和预后。通过单因素和多因素分析与成功再通相关的因素。
61例（83.6%）患者获得技术成功，并发症发生率为13.7%（10/73）。基于多因素分析，责任闭塞动脉（大脑中动脉主干（MCA）与颅内颈内动脉（ICA），P = 0.004；MCA主干与颅内椎基底动脉（VBA），P = 0.010）、有残余管腔的闭塞（P = 0.036）、有明显斑块强化的闭塞（P = 0.011）以及较短的闭塞长度（≤10.2 mm与>10.2 mm，P = 0.008）被确定为成功再通的独立阳性预测因素。根据预测模型的系数为患者分配分数，分数≤2、3、4和≥5分的患者技术成功率分别为50.0%、83.3%、95.5%和100%。
HR-MRI模式对于识别有症状CILAO血管内再通的候选者可能有价值。HR-MRI上的MCA主干闭塞、有残余管腔的闭塞、有明显斑块强化的闭塞以及较短的闭塞长度似乎与再通成功显著相关。
