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Published on: August 11, 2023
A novel subtype classification for acute intracranial atherosclerotic disease-related occlusion
Shujuan Gan1, Tingyu Yi2,3, Meihua Wu3
1Department of Neurology, Fujian Medical University Union Hospital, Fuzhou, China.
Insights
A new Thrombus-Stenosis (TS) classification system effectively categorizes intracranial atherosclerotic disease (ICAD) occlusions. This system is feasible and aids in guiding endovascular therapy (EVT) strategies for ICAD.
Area of Science:
- Vascular Neurology
- Interventional Neuroradiology
- Medical Classification Systems
Background:
- Optimal endovascular therapy (EVT) for intracranial atherosclerotic disease (ICAD)-related occlusions is uncertain.
- Pathogenesis may influence EVT strategy.
- A novel Thrombus-Stenosis (TS) classification system has been proposed to address this uncertainty.
Purpose of the Study:
- To assess the feasibility of the TS classification system.
- To evaluate the utility of the TS classification in guiding EVT strategy-making for ICAD.
Main Methods:
- ICAD defined by significant stenosis at occlusion site on angiography.
- TS classification based on thrombus presence and stenosis degree (<70% or ≥70%).
- Four raters applied TS classification; interobserver reliability assessed using kappa coefficient; EVT strategies compared across TS groups.
Main Results:
- 105 ICAD occlusion cases were classified with high interobserver agreement (κ=0.95).
- 33 cases were TS-type I, 46 TS-type II, and 26 TS-type III.
- Emergent angioplasty likelihood was significantly higher in TS-type III (44x) and TS-type II (9x) compared to TS-type I.
Conclusions:
- The TS classification system is feasible for subtyping ICAD-related occlusions.
- The TS classification is closely associated with EVT strategy-making decisions.
Background And Purposed:
The optimal endovascular therapy (EVT) strategy for intracranial atherosclerotic disease (ICAD)-related occlusion remains uncertain and may be influenced by its underlying pathogenesis. To address this, a novel classification system named Thrombus-Stenosis (TS) has been proposed. Our study aimed to assess the feasibility of the TS classification and its utility in guiding EVT strategy-making.
Methods:
ICAD was defined as a significant fixed focal stenosis at the site of occlusion evidenced by final angiography or during endovascular treatment. The TS subtype was classified based on presence of the thrombus and stenosis degree of culprit artery with three categories, TS-type I (<70% stenosis with definite thrombus), TS-type II (≥70% stenosis with definite thrombus) and TS-type III (≥70%stenosis without definite thrombus). Four independent raters used the TS classification system to subtype the included cases. Interobserver reliability was assessed using the kappa (κ) coefficient. Differences in EVT strategies between the three TS groups were compared.
Results:
A total of 105 definite ICAD-related occlusion cases were included and successfully classified into the three TS subtypes by the four independent raters, with high interobserver agreement (κ = 0.95): 33 patients with TS-type I, 46 with TS-type II, and 26 with TS-type III. Compared with TS-type I, the likelihood of performing emergent angioplasty was 44 times higher in TS-type III (95% CI, 5.1-369.8, p = 0.001) and 9 times higher in TS-type II (95% CI, 1.1-73.3, p = 0.047).
Conclusion:
The TS classification system is feasible for subtyping ICAD-related occlusions and is closely associated with EVT strategy-making.
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