Comai Alessio, Casalboni Chiara, Vingiani Vincenzo, Bonatti Matteo, Franchini Enrica, Dall'Ora Elisa, Noumsi Guensom Ghislain, Lombardo Fabio, Federica Ferro, Petralia Benedetto
Department of Neuroradiology, Teaching Hospital of Paracelsius Medical University (PMU), Hospital of Bolzano (SABES-ASDAA), Bolzano-Bozen, Italy.
Department of Radiology, Teaching Hospital of Paracelsius Medical University (PMU), Hospital of Bolzano (SABES-ASDAA), Bolzano-Bozen, Italy.
Neuroradiol J. 2025 Jan 24:19714009251313504. doi: 10.1177/19714009251313504.
Occlusion of the distal internal carotid artery can simulate a proximal occlusion of its cervical tract on CT angiography in patients with acute ischemic stroke, that is, pseudo-occlusion. As true and false carotid occlusions can present similarly on non-invasive imaging in patients undergoing endovascular treatment for stroke, our study aimed to evaluate clinical and technical differences of these conditions and the possible consequences of a misdiagnosis. We retrospectively reviewed consecutive patients who underwent mechanical thrombectomy for acute ischemic stroke at a single center between July 2015 and May 2022 and included patients with absent opacification of the cervical carotid artery on CT-angiography. Digital subtraction angiography (DSA) imaging and procedural data were evaluated to define the actual localization of the occlusion. We compared imaging and clinical data between patients with true and false carotid occlusion, including collateral circulation at CTA, revascularization grade, and clinical outcome at 3 months. A total of 116 patients were included, 63 (54%) of whom had true occlusion of cervical internal carotid artery. Compared to the pseudo-occlusion group, collateral circulation at CTA was moderate to good in 75% of cases (vs 32%; < 0.0001) and the mean ASPECT score at 24 h was 7 versus 2 ( < 0.0001). Modified Rankin scale 0-2 at 90 days was more frequent in patients with true occlusion than those with pseudo-occlusion (48 vs 11%; = 0.0002). Pseudo-occlusion of the cervical internal carotid artery in patients with acute ischemic stroke appears to be associated with worst prognosis and poorer collateral circulation in comparison with tandem occlusion.
在急性缺血性脑卒中患者中，颈内动脉远端闭塞在CT血管造影上可模拟其颈部段近端闭塞，即假性闭塞。由于在接受血管内治疗的脑卒中患者中，真性和假性颈动脉闭塞在非侵入性成像上表现相似，我们的研究旨在评估这些情况的临床和技术差异以及误诊的可能后果。我们回顾性分析了2015年7月至2022年5月在单一中心接受急性缺血性脑卒中机械取栓术的连续患者，并纳入了CT血管造影显示颈部颈动脉不显影的患者。评估数字减影血管造影（DSA）成像和手术数据以确定闭塞的实际位置。我们比较了真性和假性颈动脉闭塞患者的成像和临床数据，包括CTA时的侧支循环、再通分级和3个月时的临床结局。共纳入116例患者，其中63例（54%）颈内动脉颈部段真性闭塞。与假性闭塞组相比，CTA时75%的病例侧支循环为中度至良好（vs 32%；<0.0001），24小时时平均ASPECT评分为7分，而假性闭塞组为2分（<0.0001）。真性闭塞患者90天时改良Rankin量表评分为0 - 2分的情况比假性闭塞患者更常见（48% vs 11%；P = 0.0002）。与串联闭塞相比，急性缺血性脑卒中患者颈内动脉假性闭塞似乎与更差的预后和更差的侧支循环相关。
