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Morphological and Compositional Features of Chronic Internal Carotid Artery Occlusion in MR Vessel Wall Imaging
Jin Zhang1, Shenghao Ding2, Bing Zhao2
1Department of Radiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, 160 Pujian Road, Shanghai 200127, China.
Insights
MR vessel wall imaging features of chronic internal carotid artery occlusion (CICAO) predict successful endovascular recanalization. Specific characteristics like limited occlusion extent and extensive hyperintense signals improve prediction accuracy.
Area of Science:
- Neuroimaging
- Vascular Surgery
- Interventional Neurology
Background:
- Chronic internal carotid artery occlusion (CICAO) presents challenges for endovascular recanalization.
- Predicting procedural success is crucial for patient selection and treatment planning.
Purpose of the Study:
- To evaluate if MR vessel wall imaging (MR-VWI) features of CICAO can predict successful endovascular recanalization.
- To identify specific morphological and compositional characteristics associated with technical success.
Main Methods:
- Prospective recruitment of 83 patients with CICAO undergoing endovascular recanalization.
- Pre-procedural MR-VWI to assess features: proximal stump morphology, occlusion extent, collapse, tortuosity, hyperintense signals (HIS), and calcification.
- Multivariate logistic regression and development of an MR CICAO score for prediction.
Main Results:
- Successful recanalization was achieved in 53.7% of patients (57/83).
- Predictors of success included C1 segment occlusion, extensive HIS, and absence of extensive calcification, high tortuosity, or artery collapse.
- The developed MR CICAO score demonstrated high predictive ability (AUC: 0.888).
Conclusions:
- MR-VWI characteristics of CICAO effectively predict technical success in endovascular recanalization.
- These imaging features can guide patient selection for improved procedural outcomes.
Abstract:
Background: We sought to determine if the morphological and compositional features of chronic internal carotid artery occlusion (CICAO), as assessed by MR vessel wall imaging (MR-VWI), initially predict successful endovascular recanalization. Methods: Consecutive patients with CICAO scheduled for endovascular recanalization were recruited. MR-VWI was performed within 1 week prior to surgery for evaluating the following features: proximal stump morphology, extent of occlusion, occlusion with collapse, arterial tortuosity, the presence of hyperintense signals (HIS) and calcification in the occluded C1 segment. Multivariate logistic regression was used to identify features associated with technical success and construct a prediction model. Results: Eighty-three patients were recruited, of which fifty-seven (68.7%) were recanalized successfully. The morphological and compositional characteristics of CICAO were associated with successful recanalization, including occlusions limited to C1 and extensive HIS, as well as the absence of extensive calcification, absence of high tortuosity, and absence of artery collapse. The MR CICAO score that comprised the five predictors showed a high predictive ability (area under the curve: 0.888, p < 0.001). Conclusion: the MR-VWI characteristics of CICAO predicted the technical success of endovascular recanalization and may be leveraged for identifying patients with a high probability of successful recanalization.
