Related Experiment Videos
Microcatheter "First-Pass Effect" Predicts Acute Intracranial Artery Atherosclerotic Disease-Related Occlusion
Ting-Yu Yi1, Wen-Huo Chen1, Yan-Min Wu1
1Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, Fujian, China.
Insights
The microcatheter "first-pass effect" can accurately differentiate intracranial atherosclerotic stenosis (ICAS) from embolism in acute ischemic stroke patients. This finding aids in selecting appropriate endovascular therapy for stroke treatment.
Area of Science:
- Neurology
- Interventional Neuroradiology
- Vascular Neurology
Background:
- Differentiating intracranial atherosclerotic stenosis (ICAS) from intracranial embolism is crucial for acute ischemic stroke management.
- The microcatheter "first-pass effect" is a potential indicator observed during endovascular procedures.
Purpose of the Study:
- To assess the utility of the microcatheter first-pass effect in distinguishing ICAS from embolism in acute ischemic stroke.
- To determine the diagnostic accuracy of this phenomenon for predicting ICAS.
Main Methods:
- A study included 61 patients with acute ischemic stroke and large intracranial artery occlusion treated with endovascular therapy.
- The presence and frequency of the microcatheter first-pass effect were recorded and analyzed.
- Sensitivity, specificity, positive predictive values (PPV), and accuracy were calculated.
Main Results:
- The microcatheter first-pass effect was significantly more common in patients with ICAS (90.9%) compared to those with embolism (12.8%).
- The diagnostic performance for identifying ICAS showed high sensitivity (90.9%), specificity (87.2%), PPV (80.0%), and accuracy (88.5%).
Conclusions:
- The microcatheter first-pass effect demonstrates high sensitivity and PPV for predicting ICAS in acute ischemic stroke.
- This easily observable phenomenon can aid clinicians in differentiating stroke etiologies during endovascular treatment.
Background:
The differentiation between intracranial atherosclerotic stenosis (ICAS) and intracranial embolism as the immediate cause of acute ischemic stroke requiring endovascular therapy is important but challenging. In cases of ICAS, we often observe a phenomenon we call the microcatheter "first-pass effect," which is temporary blood flow through the occluded intracranial artery when the angiographic microcatheter is initially advanced through the site of total occlusion and immediately retrieved proximally.
Objective:
To evaluate whether this microcatheter first-pass effect can be used to differentiate ICAS from intracranial embolism.
Methods:
A total of 61 patients with acute ischemic stroke resulting from large intracranial artery occlusion and in whom recanalization was achieved by endovascular treatment were included in the study. The microcatheter first-pass effect was tested in these patients. The sensitivity, specificity, positive predictive values (PPV), and accuracy of the microcatheter first-pass effect for prediction of ICAS were assessed.
Results:
The microcatheter first-pass effect was more frequently observed in patients with ICAS than in those with intracranial embolism (90.9% vs 12.8%, P < .001). For identifying ICAS, sensitivity, specificity, PPV, and accuracy of the microcatheter first-pass effect were 90.9%, 87.2%, 80.0%, 88.5%, respectively.
Conclusion:
The sensitivity and PPV of the microcatheter first-pass effect are high for prediction of ICAS in patients with acute symptoms.