The role of carotid elongation for intervention time and outcome in mechanical thrombectomy for anterior circulation acute ischemic stroke.

IF 2.4 3区医学 Q2 CLINICAL NEUROLOGY Neuroradiology Pub Date : 2025-01-08 DOI:10.1007/s00234-024-03539-0

Vivien Lorena Ivan, Christian Rubbert, Daniel Weiß, Luisa Wolf, Marius Vach, Marius Kaschner, Bernd Turowski, Michael Gliem, John-Ih Lee, Tobias Ruck, Julian Caspers

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Abstract

Introduction: This study investigates the influence of carotid artery elongation on neurovascular intervention and outcome in acute stroke treatments proposing an easily assessable imaging marker for carotid elongation.

Methods: 118 patients who underwent mechanical thrombectomy for middle cerebral artery occlusions were included. The carotid elongation ratio (CER), center-line artery length to scan's Z-axis, was measured on the affected side in CT-angiographies. Full and partial correlations of CER with periprocedural times, complications and outcome were computed. Multivariate logistic regression, including comorbidities, for prediction of dichotomized mRS outcome after 3 months was performed.

Results: CER showed no significant correlation with recanalization success. Weak, outlier-driven correlation was found with recanalization time (p = 0.021, cor = 0.2). Weak correlations were found with improvement of NIHSS score at discharge and mRS score after 3 months (p = 0.023 and p = 0.031, each rho=-0.2). There was moderate correlation with NIHSS score at discharge (p = 0.001, rho = 0.3). Patients with favorable outcomes (mRS 0-2) exhibited lower CER (p = 0.012). Partial correlations of CER with favorable outcomes were observed after correcting for age, sex and cardiovascular risk factors (cor = 0.2, p = 0.048). Multivariate analysis (Nagelkerke's R2 = 0.42) identified NIHSS score at admission, diabetes, hypertension and intervention time as significant factors for predicting outcome at 3 month, while CER showed the highest log Odd's (2.97).

Conclusion: Correlations between CER and clinical improvement suggest that carotid elongation might be a risk factor for poorer outcome without relevant effect on endovascular treatment and should not guide treatment decisions. Further studies should consider carotid elongation as an individual neurovascular risk factor, independent of hypertension.

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颈动脉延长对前循环急性缺血性脑卒中机械取栓干预时间和结果的影响。

简介：本研究探讨了颈动脉伸长对急性脑卒中治疗中神经血管干预和预后的影响，提出了一种易于评估的颈动脉伸长成像标志物。方法：118例因大脑中动脉闭塞而行机械取栓术的患者。在ct血管造影中测量患侧颈动脉延伸比（CER），即中心线动脉与扫描z轴的长度。计算CER与围手术期、并发症和预后的全部和部分相关性。多变量逻辑回归，包括合并症，用于预测3个月后的二分类mRS结果。结果：CER与再通成功率无显著相关性。再通时间与异常值驱动的相关性较弱（p = 0.021, cor = 0.2）。出院时NIHSS评分和3个月后mRS评分的改善呈弱相关（p = 0.023和p = 0.031，各rho=-0.2）。与出院时NIHSS评分有中度相关性（p = 0.001, rho = 0.3）。预后良好的患者（mRS 0-2）的CER较低（p = 0.012）。校正年龄、性别和心血管危险因素后，观察到CER与有利结果的部分相关（cor = 0.2, p = 0.048）。多因素分析（Nagelkerke’s R2 = 0.42）发现，入院时NIHSS评分、糖尿病、高血压和干预时间是预测3个月预后的显著因素，而CER的log Odd’s最高（2.97）。结论：CER与临床改善的相关性提示颈动脉延长可能是预后较差的危险因素，对血管内治疗无相关影响，不应指导治疗决策。进一步的研究应考虑颈动脉伸长作为独立于高血压的个体神经血管危险因素。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Neuroradiology 医学-核医学

CiteScore

5.30

自引率

3.60%

发文量

214

审稿时长

4-8 weeks

期刊介绍： Neuroradiology aims to provide state-of-the-art medical and scientific information in the fields of Neuroradiology, Neurosciences, Neurology, Psychiatry, Neurosurgery, and related medical specialities. Neuroradiology as the official Journal of the European Society of Neuroradiology receives submissions from all parts of the world and publishes peer-reviewed original research, comprehensive reviews, educational papers, opinion papers, and short reports on exceptional clinical observations and new technical developments in the field of Neuroimaging and Neurointervention. The journal has subsections for Diagnostic and Interventional Neuroradiology, Advanced Neuroimaging, Paediatric Neuroradiology, Head-Neck-ENT Radiology, Spine Neuroradiology, and for submissions from Japan. Neuroradiology aims to provide new knowledge about and insights into the function and pathology of the human nervous system that may help to better diagnose and treat nervous system diseases. Neuroradiology is a member of the Committee on Publication Ethics (COPE) and follows the COPE core practices. Neuroradiology prefers articles that are free of bias, self-critical regarding limitations, transparent and clear in describing study participants, methods, and statistics, and short in presenting results. Before peer-review all submissions are automatically checked by iThenticate to assess for potential overlap in prior publication.