Defining carotid near-occlusion with full collapse: a pooled analysis

Area of Science:

• Vascular Neurology
• Radiology
• Cardiovascular Imaging

Background:

• Carotid stenosis is a major risk factor for ischemic stroke.
• Near-occlusion with full collapse is a challenging subset of carotid stenosis.
• Accurate prediction of recurrent stroke in these patients is crucial for timely intervention.

Purpose of the Study:

• To develop and validate a new definition for near-occlusion with full collapse.
• To improve the prediction of recurrent ipsilateral ischemic stroke or retinal artery occlusion within 28 days.

Main Methods:

• Pooled analysis of 430 patients with symptomatic ≥50% carotid stenosis.
• Evaluation of distal internal carotid artery (ICA) diameter, ICA ratio, and ICA-to-external carotid artery ratio on computed tomography angiography.
• Comparison of traditional versus a novel definition for full collapse in predicting outcomes.

Main Results:

• 27% of patients had near-occlusion with full collapse by traditional definition.
• The novel definition (distal ICA diameter ≤2.0 mm and/or ICA ratio ≤0.42) significantly improved outcome prediction.
• Using the new definition, 36% with full collapse and 4% without full collapse reached the outcome (p < 0.001), compared to 27% and 11% (p=0.047) by the traditional definition.

Conclusions:

• The proposed definition of near-occlusion with full collapse (distal ICA diameter ≤2.0 mm and/or ICA ratio ≤0.42) offers superior prognostic discrimination.
• This novel definition can enhance prognostic and treatment studies for patients with near-occlusion and full collapse.
• Improved identification of high-risk patients may lead to more targeted therapeutic strategies.