Diagnostic Value of Perfusion Parameters for Differentiation of Underlying Etiology in Internal Carotid Artery Occlusions.
Dissection
Embolic
Endovascular treatment
Macroangiopathy
Stroke
Journal
Clinical neuroradiology
ISSN: 1869-1447
Titre abrégé: Clin Neuroradiol
Pays: Germany
ID NLM: 101526693
Informations de publication
Date de publication:
26 Oct 2023
26 Oct 2023
Historique:
received:
27
12
2022
accepted:
08
09
2023
medline:
27
10
2023
pubmed:
27
10
2023
entrez:
26
10
2023
Statut:
aheadofprint
Résumé
Occlusions of the internal carotid artery (ICA) may be caused by dissection, embolic or macroangiopathic pathogenesis, which partially influences the treatment; however, inferring the underlying etiology in computed tomography angiography can be challenging. In this study, we investigated whether computed tomography perfusion (CT-P) parameters could be used to distinguish between etiologies. Patients who received CT‑P in acute ischemic stroke due to ICA occlusion between 2012 and 2019 were retrospectively analyzed. Group comparisons between etiologies regarding the ratios of CT‑P parameters between both hemispheres for relative cerebral blood volume (rCBV), relative cerebral blood flow (rCBF), time to maximum (Tmax), and mean transit time (MTT) were calculated by one-factorial analysis of variance (ANOVA) and compared by pairwise Bonferroni post hoc tests. An receiver operating characteristics (ROC) analysis was performed if differences in group comparisons were found. Multinomial logistic regression (MLR) including pretherapeutic parameters was calculated for etiologies. In this study 69 patients (age = 70 ± 14 years, dissection = 10, 14.5%, embolic = 19, 27.5% and macroangiopathic = 40, 58.0%) were included. Group differences in ANOVA were only found for MTT ratio (p = 0.003, η It was possible to differentiate between patients with embolic and macroangiopathic ICA occlusions based on MTT ratios and to define a corresponding cut-off. Differentiation from patients with dissection versus the other etiologies was not possible by CT‑P parameters in our sample.
Identifiants
pubmed: 37884790
doi: 10.1007/s00062-023-01349-0
pii: 10.1007/s00062-023-01349-0
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2023. The Author(s).
Références
Weimar C, Goertler M, Harms L, Diener H‑C. Distribution and outcome of symptomatic stenoses and occlusions in patients with acute cerebral ischemia. Arch Neurol. 2006;63:1287–91.
doi: 10.1001/archneur.63.9.1287
pubmed: 16966507
Xu B, Li C, Guo Y, Xu K, Yang Y, Yu J. Current understanding of chronic total occlusion of the internal carotid artery. Biomed Rep. 2018;8:117–25.
pubmed: 29435269
Lee JI, Jander S, Oberhuber A, Schelzig H, Hänggi D, Turowski B, Seitz RJ. Stroke in patients with occlusion of the internal carotid artery: options for treatment. Expert Rev Neurother. 2014;14:1153–67.
doi: 10.1586/14737175.2014.955477
pubmed: 25245575
Goldberg HI, Grossman RI, Gomori JM, Asbury AK, Bilaniuk LT, Zimmerman RA. Cervical internal carotid artery dissecting hemorrhage: diagnosis using MR. Radiology. 1986;158:157–61.
doi: 10.1148/radiology.158.1.3940374
pubmed: 3940374
Akpınar S, Gelener P, Yilmaz G. Aetiologies of internal carotid artery pseudo-occlusions in acute stroke patients: what neurointerventionalists can expect. Br J Radiol. 2017;90:20160352.
doi: 10.1259/bjr.20160352
pubmed: 27995806
pmcid: 5685129
Sugg RM, Malkoff MD, Noser EA, Shaltoni HM, Weir R, Cacayorin ED, Grotta JC. Endovascular recanalization of internal carotid artery occlusion in acute ischemic stroke. AJNR Am J Neuroradiol. 2005;26:2591–4.
pubmed: 16286407
pmcid: 7976190
Parthasarathy R, Goel G, Gupta V, Singhal V, Sehgal J, Garg A, Singh S. Acute ischemic stroke with tandem/terminal ICA occlusion—CT perfusion based case selection for mechanical recanalization. Neurol India. 2015;63:369–77.
doi: 10.4103/0028-3886.158211
pubmed: 26053809
Kimura K, Yonemura K, Terasaki T, Hashimoto Y, Uchino M. Duplex carotid sonography in distinguishing acute unilateral atherothrombotic from cardioembolic carotid artery occlusion. AJNR Am J Neuroradiol. 1997;18:1447–52.
pubmed: 9296185
pmcid: 8338137
Jin X, Shi F, Chen Y, Zheng X, Zhang J. Jet-like appearance in angiography as a predictive image marker for the occlusion of intracranial atherosclerotic stenosis. Front Neurol. 2020;11:575567.
doi: 10.3389/fneur.2020.575567
pubmed: 33193024
pmcid: 7661688
Grau AJ, Weimar C, Buggle F, Heinrich A, Goertler M, Neumaier S, Glahn J, Brandt T, Hacke W, Diener H‑C. Risk factors, outcome, and treatment in subtypes of ischemic stroke. Stroke. 2001;32:2559–66.
doi: 10.1161/hs1101.098524
pubmed: 11692017
Boodt N, Compagne KCJ, Dutra BG, Samuels N, Tolhuisen ML, Alves H, Kappelhof M, et al. Stroke etiology and thrombus computed tomography characteristics in patients with acute ischemic stroke: a MR CLEAN registry substudy. Stroke. 2020;51:1727–35.
doi: 10.1161/STROKEAHA.119.027749
pubmed: 32404040
Bokkers RP, van Osch MJ, Klijn CJ, Kappelle LJ, Hendrikse J. Cerebrovascular reactivity within perfusion territories in patients with an internal carotid artery occlusion. J Neurol Neurosurg Psychiatry. 2011;82:1011–6.
doi: 10.1136/jnnp.2010.233338
pubmed: 21386110
Guglielmi V, LeCouffe NE, Zinkstok SM, Compagne KCJ, Eker R, Treurniet KM, Tolhuisen ML, van der Worp HB, Jansen IGH, van Oostenbrugge RJ, Marquering HA, Dippel DWJ, Emmer BJ, Majoie CBLM, Roos YBWEM, Coutinho JM. Collateral circulation and outcome in atherosclerotic versus cardioembolic cerebral large vessel occlusion. Stroke. 2019;50:3360–8.
doi: 10.1161/STROKEAHA.119.026299
pubmed: 31658903
pmcid: 7597992
Adams HP Jr., Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, Marsh EE 3rd. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in acute stroke treatment. Stroke. 1993;24:35–41.
doi: 10.1161/01.STR.24.1.35
pubmed: 7678184
Silvennoinen HM, Ikonen S, Soinne L, Railo M, Valanne L. CT angiographic analysis of carotid artery stenosis: comparison of manual assessment, semiautomatic vessel analysis, and digital subtraction angiography. AJNR Am J Neuroradiol. 2007;28:97–103.
pubmed: 17213433
pmcid: 8134104
Gliem M, Lee JI, Barckhan A, Turowski B, Hartung HP, Jander S. Outcome and treatment effects in stroke associated with acute cervical ICA occlusion. PLoS ONE. 2017;12:e170247.
doi: 10.1371/journal.pone.0170247
pubmed: 28081270
pmcid: 5231377
Malhotra K, Goyal N, Tsivgoulis G. Internal carotid artery occlusion: pathophysiology, diagnosis, and management. Curr Atheroscler Rep. 2017;19:41.
doi: 10.1007/s11883-017-0677-7
pubmed: 28861849
Rodallec MH, Marteau V, Gerber S, Desmottes L, Zins M. Craniocervical arterial dissection: spectrum of imaging findings and differential diagnosis. Radiographics. 2008;28:1711–28.
doi: 10.1148/rg.286085512
pubmed: 18936031
Jaberi A, Lum C, Stefanski P, Thornhill R, Iancu D, Petrcich W, Momoli F, Torres C, Dowlatshahi D. Computed tomography angiography intraluminal filling defect is predictive of internal carotid artery free-floating thrombus. Neuroradiology. 2014;56:15–23.
doi: 10.1007/s00234-013-1298-7
pubmed: 24212333
Blum CA, Yaghi S. Cervical artery dissection: a review of the epidemiology, pathophysiology, treatment, and outcome. Arch Neurosci. 2015;2(4):e26670. https://doi.org/10.5812/archneurosci.26670 .
doi: 10.5812/archneurosci.26670
pubmed: 26478890
pmcid: 4604565
Chen YF, Tang SC, Wu WC, Kao HL, Kuo YS, Yang SC. Alterations of cerebral perfusion in asymptomatic internal carotid artery steno-occlusive disease. Sci Rep. 2017;7:1841.
doi: 10.1038/s41598-017-02094-4
pubmed: 28500300
pmcid: 5431826
Rebello LC, Bouslama M, Haussen DC, Grossberg JA, Dehkharghani S, Anderson A, Belagaje SR, Bianchi NA, Grigoryan M, Frankel MR, Nogueira RG. Stroke etiology and collaterals: atheroembolic strokes have greater collateral recruitment than cardioembolic strokes. Eur J Neurol. 2017;24:762–7.
doi: 10.1111/ene.13287
pubmed: 28432712
Uniken Venema SM, Dankbaar JW, van der Lugt A, Dippel DWJ, van der Worp HB. Cerebral collateral circulation in the era of reperfusion therapies for acute ischemic stroke. Stroke. 2022;53:3222–34.
doi: 10.1161/STROKEAHA.121.037869
pubmed: 35938420
Laslo AM, Eastwood JD, Pakkiri P, Chen F, Lee TY. CT perfusion-derived mean transit time predicts early mortality and delayed vasospasm after experimental subarachnoid hemorrhage. AJNR Am J Neuroradiol. 2008;29:79.
doi: 10.3174/ajnr.A0747
pubmed: 17965139
pmcid: 8119087
Lin CH, Tsai YH, Lee JD, Weng HH, Yang JT, Lin LC, Lin YH, Wu CY, Huang YC, Hsu HL, Lee M, Hsu CY, Pan YT, Huang YC. Magnetic resonance perfusion imaging provides a significant tool for the identification of cardioembolic stroke. Curr Neurovasc Res. 2016;13:271–6.
doi: 10.2174/1567202613666160901143040
pubmed: 27586679
pmcid: 5068491
Chen C‑J, Green IE, Worrall BB, Southerland AM. Cerebral collaterals and stroke in patients with isolated carotid artery dissections. J Clin Neurosci. 2020;72:158–62.
doi: 10.1016/j.jocn.2019.12.038
pubmed: 31937504