Ivan Vivien Lorena, Rubbert Christian, Weiß Daniel, Wolf Luisa, Vach Marius, Kaschner Marius, Turowski Bernd, Gliem Michael, Lee John-Ih, Ruck Tobias, Caspers Julian
Department of Diagnostic and Interventional Radiology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany.
Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany.
Neuroradiology. 2025 Feb;67(2):403-413. doi: 10.1007/s00234-024-03539-0. Epub 2025 Jan 8.
This study investigates the influence of carotid artery elongation on neurovascular intervention and outcome in acute stroke treatments proposing an easily assessable imaging marker for carotid elongation.
118 patients who underwent mechanical thrombectomy for middle cerebral artery occlusions were included. The carotid elongation ratio (CER), center-line artery length to scan's Z-axis, was measured on the affected side in CT-angiographies. Full and partial correlations of CER with periprocedural times, complications and outcome were computed. Multivariate logistic regression, including comorbidities, for prediction of dichotomized mRS outcome after 3 months was performed.
CER showed no significant correlation with recanalization success. Weak, outlier-driven correlation was found with recanalization time (p = 0.021, cor = 0.2). Weak correlations were found with improvement of NIHSS score at discharge and mRS score after 3 months (p = 0.023 and p = 0.031, each rho=-0.2). There was moderate correlation with NIHSS score at discharge (p = 0.001, rho = 0.3). Patients with favorable outcomes (mRS 0-2) exhibited lower CER (p = 0.012). Partial correlations of CER with favorable outcomes were observed after correcting for age, sex and cardiovascular risk factors (cor = 0.2, p = 0.048). Multivariate analysis (Nagelkerke's R2 = 0.42) identified NIHSS score at admission, diabetes, hypertension and intervention time as significant factors for predicting outcome at 3 month, while CER showed the highest log Odd's (2.97).
Correlations between CER and clinical improvement suggest that carotid elongation might be a risk factor for poorer outcome without relevant effect on endovascular treatment and should not guide treatment decisions. Further studies should consider carotid elongation as an individual neurovascular risk factor, independent of hypertension.
本研究探讨颈动脉延长对急性卒中治疗中神经血管介入及预后的影响，提出一种易于评估的颈动脉延长影像学标志物。
纳入118例行大脑中动脉闭塞机械取栓术的患者。在CT血管造影上测量患侧的颈动脉延长率（CER），即中心线动脉长度与扫描Z轴的比值。计算CER与围手术期时间、并发症及预后的完全和部分相关性。进行多因素逻辑回归分析，包括合并症，以预测3个月后改良Rankin量表（mRS）二分法结局。
CER与再通成功无显著相关性。发现CER与再通时间存在弱的、受异常值驱动的相关性（p = 0.021，cor = 0.2）。与出院时美国国立卫生研究院卒中量表（NIHSS）评分改善及3个月后mRS评分存在弱相关性（分别为p = 0.023和p = 0.031，rho均为-0.2）。与出院时NIHSS评分存在中度相关性（p = 0.001，rho = 0.3）。预后良好（mRS 0-2）的患者CER较低（p = 0.012）。在校正年龄、性别和心血管危险因素后，观察到CER与良好预后的部分相关性（cor = 0.2，p = 0.048）。多因素分析（Nagelkerke's R2 = 0.42）确定入院时NIHSS评分、糖尿病、高血压和介入时间是预测3个月结局的重要因素，而CER显示出最高的对数优势（2.97）。
CER与临床改善之间的相关性表明，颈动脉延长可能是预后较差的危险因素，对血管内治疗无相关影响，不应指导治疗决策。进一步研究应将颈动脉延长视为独立于高血压的个体神经血管危险因素。
