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Radiological features on high-resolution MR imaging predicts successful recanalization in patients with symptomatic
Chun Zhou1, Yue-Zhou Cao1, Zhen-Yu Jia1
1Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing 210029, China (C.Z., Y-Z.C., Z-Y.J., L-B.Z., H-B.S., S.L.).
Insights
High-resolution MRI can predict successful endovascular recanalization in symptomatic chronic intracranial large artery occlusion (CILAO). Key predictors include MCA trunk occlusion, residual lumen, plaque enhancement, and shorter occlusion length.
Area of Science:
- Neurology
- Interventional Radiology
- Medical Imaging
Background:
- Endovascular recanalization is used for symptomatic chronic intracranial large artery occlusion (CILAO).
- Recanalization outcomes vary, posing challenges for clinical application.
Purpose of the Study:
- To identify radiological features on high-resolution MRI (HR-MRI) that predict successful recanalization in symptomatic CILAO patients.
- To develop a predictive model for endovascular recanalization success.
Main Methods:
- Retrospective analysis of 73 patients with symptomatic CILAO undergoing endovascular recanalization.
- Evaluation of clinical data, HR-MRI characteristics, procedural results, and outcomes.
- Univariate and multivariate analyses to identify predictors of successful recanalization.
Main Results:
- Technical success was achieved in 83.6% of patients.
- Independent predictors of successful recanalization included MCA trunk occlusion, presence of residual lumen, marked plaque enhancement, and shorter occlusion length (≤10.2 mm).
- A scoring system based on these predictors demonstrated increasing technical success rates with higher scores.
Conclusions:
- HR-MRI is valuable for selecting candidates for endovascular recanalization in symptomatic CILAO.
- MCA trunk occlusion, residual lumen, plaque enhancement, and shorter occlusion length on HR-MRI are significant predictors of successful recanalization.
Rationale And Objectives:
Endovascular recanalization has been attempted in patients with symptomatic chronic intracranial large artery occlusion (CILAO), however, the heterogeneity of recanalization outcomes present challenges for the clinical application.
Objective:
To determine the radiological features on high-resolution MR imaging (HR-MRI) for predicting successful recanalization of symptomatic CILAO.
Methods:
Seventy-three patients with symptomatic CILAO who underwent endovascular recanalization at our center were retrospectively analyzed. Patients' clinical information, HR-MRI characteristics, procedural results, and outcomes were recorded. Factors related to successful recanalization were analyzed by univariate and multivariate analyses.
Results:
Technical success was achieved in 61 (83.6%) patients, with a complication rate of 13.7% (10/73). Based on multivariate analysis, responsible occluded artery (middle cerebral artery (MCA) trunk versus intracranial internal carotid artery (ICA), P = 0.004; MCA trunk versus intracranial vertebrobasilar artery (VBA), P = 0.010), occlusion with residual lumen (P = 0.036), occlusion with marked plaque enhancement (P = 0.011), and shorter occlusion length (≤10.2 mm versus >10.2 mm, P = 0.008) were identified as independent positive predictors of successful recanalization. Patients were assigned score points according to the coefficients of the prediction model, and the technical success rates were 50.0%, 83.3%, 95.5%, and 100% in patients with score ≤ 2, 3, 4, and ≥ 5 points, respectively.
Conclusions:
The HR-MRI modality may be valuable in identifying candidates for endovascular recanalization of symptomatic CILAO. MCA trunk occlusion, occlusion with residual lumen, occlusion with marked plaque enhancement and shorter occlusion length on HR-MRI appear to be significantly associated with the success of recanalization.
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