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Published on: February 22, 2013
Prediction of Occlusion Duration in Nonacute Intracranial Large Artery Through High-Resolution Vessel Wall Imaging
Chen Cao1, Song Liu1, Huiying Wang2
1Department of Radiology, Tianjin Huanhu Hospital Nankai University Tianjin China.
Insights
High-resolution vessel wall imaging accurately differentiates intracranial large vessel occlusion (ILVO) durations. This imaging can guide endovascular treatment, improving outcomes for subacute and short-duration chronic ILVOs.
Area of Science:
- Neurology
- Radiology
- Vascular Imaging
Background:
- Accurate assessment of intracranial large vessel occlusion (ILVO) duration is crucial for effective endovascular treatment.
- Occlusion duration significantly impacts treatment efficacy, with longer durations (>3 months) reducing success rates.
Purpose of the Study:
- To explore high-resolution vessel wall imaging (HR-VWI) for differentiating subacute, short-duration chronic, and long-duration chronic ILVOs.
- To identify imaging features that distinguish between different ILVO durations.
- To correlate ILVO duration with endovascular treatment outcomes.
Main Methods:
- Retrospective analysis of 218 nonacute ILVO cases (June 2018-March 2022).
- Evaluation of high-resolution vessel wall imaging features (pre- and postcontrast, histogram characteristics).
- Logistic regression to identify determinants of occlusion duration; assessment of endovascular treatment outcomes.
Main Results:
- Multivariate analysis identified signal intensity, enhancement index, precontrast skewness, and postcontrast coefficient of variation as key differentiators for subacute vs. long-duration chronic ILVOs.
- Signal intensity, enhancement index, lumen diameter, and precontrast skewness distinguished short-duration from long-duration chronic ILVOs.
- Short-duration ILVOs demonstrated higher recanalization success (91.7%) and required fewer stents (45.8%) compared to long-duration ILVOs (61.9% and 90.5%, respectively).
Conclusions:
- High-resolution vessel wall imaging features effectively differentiate ILVO durations.
- These imaging insights aid in understanding occluded vessel structure and guiding endovascular recanalization strategies.
- Occlusion duration is a critical factor in planning endovascular treatment for ILVO.
Background:
Accurately assessing the duration of nonacute intracranial large vessel occlusion (ILVO) is critical, because occlusion exceeding 3 months significantly reduces endovascular treatment efficacy. This study explores high-resolution vessel wall imaging to differentiate subacute (3 days-1 month), short-duration chronic (1-3 months), and long-duration chronic (>3 months) ILVOs.
Methods:
A retrospective analysis was conducted on consecutive patients with nonacute ILVOs with well-documented clinical courses (June 2018-March 2022). High-resolution vessel wall imaging pre- and postcontrast features, including traditional and histogram characteristics, were evaluated. Logistic regression identified key determinants for distinguishing occlusion durations. Endovascular treatment outcomes were assessed in a subset of patients.
Results:
Among 218 ILVOs (77 subacute, 69 short-duration chronic, 72 long-duration chronic), multivariate analysis identified signal intensity (odds ratio [OR], 3.71; P<0.001), enhancement index (OR, 1.79; P<0.001), precontrast skewness (OR, 4.41; P=0.04), and postcontrast coefficient of variation (OR, 9.34; P<0.001) as significant for differentiating subacute and long-duration chronic ILVOs. Short- versus long-duration chronic ILVOs were distinguished by signal intensity (OR, 4.02; P<0.001), enhancement index (OR, 2.02; P<0.001), lumen diameter (OR, 1.70; P=0.002), and precontrast skewness (OR, 4.91; P=0.047). Short-duration ILVOs showed higher recanalization success (91.7% versus 61.9%, P=0.02) and required fewer stents (45.8% versus 90.5%, P=0.02) compared with long-duration ILVOs.
Conclusions:
High-resolution vessel wall imaging features effectively differentiate ILVO durations, providing structural insights into occluded vessels. These findings can guide endovascular recanalization strategies, emphasizing the importance of occlusion duration in treatment planning.
