Abstract
Objective: We performed this study to evaluate the hemodynamic changes over time after successful endovascular recanalization in patients with symptomatic chronic intracranial artery occlusion (CIAO).Materials and Methods: We included 20 patients with symptomatic CIAO in a high-volume stroke center from June 2014 to June 2019. All subjects were evaluated with CT perfusion (CTP) studies before and after the recanalization. The relative cerebral blood flows (rCBFs) in perforating artery territory (PAT) and cortical artery territory (CAT) of occluded arteries were compared before and after the recanalization. The patients were categorized into subgroups based on the time interval from revascularization to post-procedural CTP, occlusion sites, and restenosis status. The proportion of rCBF change (rCBFc%) was compared in variable subgroups.Results: The rCBF increased significantly from 0.52 to 0.71 in PAT (P < 0.001) and from 0.59 to 0.85 in CAT (P < 0.001) after recanalization, and there were also statistical differences in variable subgroups except for those with restenosis. The median and interquartile range (IQR) of rCBFc% were 35.2 and 18.6–56.6%. For patients with short-term follow-up (55.2%), the rCBFc% was relatively higher than that in patients with mid-term (35.4%) and long-term follow-up (32.7%), although without statistical difference (P = 0.273). For patients with restenosis, the rCBFc% was significantly lower than that in patients without restenosis (18.5 vs. 37.3%, P = 0.008).Conclusions: In patients with symptomatic CIAO, the CBF may increase and be relatively stable over time after successful recanalization except for restenosis.
Highlights
Stroke has become the first most common and disabling disease in China, and intracranial artery stenosis or occlusion is one of the leading causes of ischemic stroke in Asian populations [1, 2]
The rCBFc% was significantly lower than that in patients without restenosis (18.5 vs. 37.3%, P = 0.008)
Previous studies had suggested that CT perfusion (CTP) imaging provides several radiological markers to assess cerebral hemodynamic changes after successful revascularization in patients with chronically occluded cervical internal carotid artery (ICA), and improvement in cerebral blood flow (CBF) is associated with significant improvement in neurocognitive functions [11,12,13]
Summary
Stroke has become the first most common and disabling disease in China, and intracranial artery stenosis or occlusion is one of the leading causes of ischemic stroke in Asian populations [1, 2]. Given the high risk of recurrent stroke in patients with CIAO, endovascular angioplasty and stenting have been performed in clinical practice and some studies [5,6,7,8,9,10]. Given the establishment of collateral circulation associated with chronic occlusions, it remains uncertain whether the CBF increases and what is the tendency of CBF change over time after successful recanalization. Previous studies had suggested that CT perfusion (CTP) imaging provides several radiological markers (especially CBF) to assess cerebral hemodynamic changes after successful revascularization in patients with chronically occluded cervical internal carotid artery (ICA), and improvement in CBF is associated with significant improvement in neurocognitive functions [11,12,13].
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