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Author Spotlight: Assessing Ischemic Stroke Damage Through Middle Cerebral Artery Occlusion Model
Published on: August 11, 2023
The relationship between occlusion patterns and outcomes after thrombectomy in patients with acute internal carotid
Xin Xu1, Chuyuan Ni2, Kangfei Wu1
1Department of Neurology, Yijishan Hospital, Wannan Medical College, 2# Zheshan West Road, Wuhu, Anhui province 241001, China.
Insights
Occlusion patterns in acute internal carotid artery occlusions (AICO) impact endovascular thrombectomy (EVT) outcomes. Compensatory leptomeningeal collaterals (LMC) may mediate this association, influencing patient prognosis.
Area of Science:
- Neurology
- Interventional Neuroradiology
- Vascular Medicine
Background:
- Acute internal carotid artery occlusions (AICO) are linked to severe disability and mortality.
- Endovascular thrombectomy (EVT) is a critical treatment for AICO.
- Understanding factors influencing EVT success is crucial for improving patient outcomes.
Purpose of the Study:
- To investigate the influence of different AICO occlusion patterns on clinical outcomes in patients undergoing EVT.
- To assess the role of leptomeningeal collaterals (LMC) in mediating the relationship between occlusion patterns and prognosis.
Main Methods:
- Retrospective analysis of EVT patient data from two stroke centers.
- Categorization of AICO occlusion patterns into I-type, L-type, and T-type.
- Assessment of LMC using the ASITN/SIR scale.
- Multivariate regression to analyze the association between occlusion patterns, LMC, and 90-day functional outcomes.
Main Results:
- 142/213 patients achieved successful reperfusion; 64/213 had favorable 90-day outcomes.
- I-type occlusions showed significantly higher rates of complete LMC compared to L-type and T-type.
- T-type occlusion was not an independent predictor of poor outcome after adjusting for LMC.
Conclusions:
- Occlusion patterns in AICO warrant attention for EVT planning.
- Leptomeningeal collaterals (LMC) play a significant role in the association between occlusion patterns and functional prognosis.
- Combined assessment of occlusion patterns and LMC status is vital for predicting EVT success and clinical outcomes in AICO.
Background And Purposes:
Ischemic stroke caused by acute internal carotid artery occlusions (AICO) is usually associated with high disability and mortality. We aimed to investigate whether occlusion patterns significantly influence clinical outcome in patients receiving endovascular thrombectomy (EVT).
Patients And Methods:
We performed a retrospective analysis of databases from two comprehensive stroke centers and consecutively investigated patients who had underwent EVT. AICO was defined as acute internal carotid artery occlusions (cervical segment to terminal segment). The clinical characteristics, intervention parameters, and prognosis data were collected. Leptomeningeal collaterals (LMC) were assessed with the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology scale (ASITN/SIRs), graded on a 5-point scale. The occlusion patterns based on Willisian collaterals were categorized into I-type, L-type, and T-type by contralateral carotid artery injections at digital subtraction angiography. Multivariate regression models were applied to evaluate the relationship between occlusion patterns and the prognosis of patients at 90 days after stroke.
Results:
A total of 213 patients were included in the study. Of those,142 (66.7%) achieved successful reperfusion and 64 (30.0%) achieved favorable outcomes at 90 days. Overall, 26 (12.2%), 117 (54.9%), and 70 (32.9%) cases respectively suffered from I-type, L-type, and T-type occlusion. In addition, patients with I-type occlusions had a higher percentage of complete LMC compared with L-type or T-type occlusions (88.5% versus 30.8% versus 27.1%, P< 0.0167). In multivariable logistic regression, we found T-type occlusion was no longer an independent predictor of poor functional outcomes in AICO after adjusting LMC (T versus I, OR, 2.555, 95%CI: 0.717-9.103, P = 0.148; L versus I, OR, 0.815, 95%CI: 0.258-2.574, P = 0.727).
Conclusions:
For ACIO, occlusion patterns are still a topic that needs attention. Furthermore, compensatory LMC may affect the association between occlusion patterns and functional prognosis in AICO. Occlusion patterns and LMC status distinguish the nature and impact of AICO on expected EVT and subsequent clinical outcomes.
