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Published on: July 21, 2013
Stent-unsheathed effect predicts acute distal middle cerebral artery atherosclerotic disease-related occlusion
Wen-Huo Chen1, Ting-Yu Yi1, A-Lai Zhan2
1Department of Neurointervention, Zhangzhou affiliated Hospital of Fujian Medical University, Fujian, China.
Insights
The post-stent-deployment effect is a reliable indicator for differentiating intracranial atherosclerosis (ICAS) from embolism in acute distal M1 segment occlusions. This finding aids in accurate diagnosis and treatment selection for stroke patients.
Area of Science:
- Neurology
- Vascular Neurology
- Interventional Neurology
Background:
- Differentiating intracranial atherosclerosis (ICAS) from embolism is crucial for effective stroke management.
- Acute distal M1 segment occlusions present diagnostic challenges.
Purpose of the Study:
- To evaluate the "post-stent-deployment effect" as a tool to distinguish ICAS from embolism in acute distal M1 segment occlusions.
- To assess the diagnostic performance of this effect.
Main Methods:
- Retrospective study of 80 patients with acute distal M1 segment occlusion treated with endovascular therapy.
- Assessment of the post-stent-deployment effect (visibility of major branches beyond occlusion post-stent deployment).
- Calculation of sensitivity, specificity, PPV, and accuracy for predicting ICAS.
Main Results:
- The post-stent-deployment effect was observed in 100% of ICAS cases versus 15.0% of embolism cases (P < .001).
- For identifying ICAS, the effect demonstrated 100% sensitivity, 85.0% specificity, 69.0% PPV, and 88.7% accuracy.
- The effect was significantly more frequent in ICAS.
Conclusions:
- The post-stent-deployment effect is a highly sensitive and accurate predictor of ICAS in acute distal M1 segment occlusions.
- This phenomenon can be a valuable tool for identifying ICAS lesions in clinical practice.
Background:
The differentiation of intracranial atherosclerosis (ICAS) and embolism is important.
Objective:
In cases of ICAS, we observe a phenomenon that we call the "post-stent-deployment effect"; that is, all major branches are clearly visible beyond the occlusion segment when the stent is deployed at the site of occlusion. Our objective is to evaluates whether this post-stent-deployment effect can be used to differentiate ICAS from embolism in the distal M1 segment occlusion.
Methods:
We conduct a retrospective study which reviewed consecutive patients with acute distal M1 segment and in whom recanalization was achieved by endovascular treatment. The post-stent-deployment effect was assessed in these patients. The sensitivity, specificity, positive predictive values (PPV), and accuracy of the post-stent-deployment effect for prediction of ICAS were assessed.
Results:
From January 2015 to July 2018, a total of 80 patients were evaluated. The post-stent-deployment effect was more frequently observed in patients with ICAS than in those with embolism (100% vs 15.0%, P < .001). For identifying ICAS in distal M1 segment, the sensitivity, specificity, PPV, and accuracy of the post-stent-deployment effect were 100%, 85.0%, 69.0%, and 88.7%, respectively.
Conclusion:
Our study finds that the sensitivity and accuracy of the post-stent-deployment effect in predicting distal M1 segment ICAS occlusion in patients with acute symptoms was high, and it may be useful in identifying ICAS lesion.
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