Factors Distinguishing Proximal and Distal Internal Carotid Artery Occlusions in Patients with Acute Ischemic Stroke.

Sang Woo Ha,Seung Jae Lee,Eung Koo Yeon,Byoung-Soo Shin,Hyun Goo Kang,Hak Sung Kim,Chan-Hyuk Lee

doi:10.3390/diagnostics12020494

Abstract

Acute internal carotid artery (ICA) occlusions cause extensive brain ischemia. Accurate determination of the occlusion site facilitates rapid revascularization interventions and improves prognosis. However, proximal ICA occlusions, as determined with computed tomography (CT) angiography, often are located more distally. Therefore, we assessed clinical and imaging factors associated with the accurate determination of occlusion sites. In this observational study, we evaluated 102 patients who presented acute ischemic stroke symptoms and had a CT angiography within 6 h, showing proximal ICA occlusion. The participants were divided into two groups, depending on whether there was correspondence between digital subtraction angiography and CT angiography regarding the occlusion location. Proximal occlusions were, accordingly, categorized as “true” (correspondence) or “false” (no correspondence; distal). Demographic, clinical, and imaging features were analyzed. Multivariate regression analysis was performed to identify factors predicting the correspondence between actual ICA occlusion sites and those detected by CT angiography. The shape (Odds ratios, OR = 646.584; Confidence interval, CI = 21.703–19263.187; p < 0.001) and the length (OR = 0.696; CI = 0.535–0.904; p = 0.007) of the ICA occlusion and atrial fibrillation (OR = 0.024; CI = 0.002–0.340; p = 0.006) were significant factors. The cut-off length of ICA stump at 6.2 mm, the sensitivity was 71%, and the specificity was 70% (area under the ROC curve = 0.767).

Highlights

The internal carotid artery (ICA) supplies blood to approximately 70% of the brain parenchyma
ICA occlusions often result in ischemic strokes affecting an extensive brain volume, and the prognosis of patients with such occlusions is often poor [1]
We examined the factors indicating the correct determination of the occlusion site in patients with acute ischemic stroke showing as a proximal ICA occlusion based on computed tomography (CT) angiography

Summary

Introduction

The internal carotid artery (ICA) supplies blood to approximately 70% of the brain parenchyma. ICA occlusions often result in ischemic strokes affecting an extensive brain volume, and the prognosis of patients with such occlusions is often poor [1]. An ischemic stroke is caused by atherosclerosis in a major artery or cardioembolism [2,3]. When a patient suspected to have stroke is hospitalized, non-enhanced brain computed tomography (CT) is performed initially to rule out intracranial hemorrhage. If the results are negative, CT angiography is performed to examine the major cerebral arteries. Based on CT angiography, an ICA occlusion may be defined as proximal regardless of the actual occlusion site [5,6,7]. For patients with suspected ICA occlusion, determining the actual occlusion site before intra-arterial (IA)

Methods

Discussion

Conclusion