血管内治疗前高分辨率磁共振血管壁成像重构指数预测颅内动脉粥样硬化性大血管闭塞性卒中

The remodeling index of high-resolution magnetic resonance vessel wall imaging before endovascular therapy predicts intracranial atherosclerotic stroke caused by large vessel occlusion

目的探讨高分辨率磁共振血管壁成像(high-resolution magnetic resonance vessel wall imaging,HRMR-VWI)特征对颅内大血管闭塞(large vessel occlusion,LVO)所致急性缺血性卒中(acute ischemic stroke,AIS)病因的预测价值。方法回顾性收集2019年8月1日至2022年8月1日期间扬州大学附属医院诊断为LVO所致AIS的患者。所有患者在发病后4.5~24 h期间接受HRMR-VWI评估以及血管内治疗。首过直接抽吸术后闭塞血管实现完全再通定义为栓塞性LVO,首过直接抽吸术后残余狭窄>50%归类为颅内动脉粥样硬化狭窄相关性LVO(intracranial atherosclerotic stenosis-related LVO,ICAS-LVO)。结果共纳入28例患者,年龄(65.32±2.23)岁,男性20例(71.4%);embo-LVO组22例(78.6%),ICAS-LVO组6例(21.4%)。多变量logistic回归分析显示,在HRMR-VWI影像特征中,重构指数是ICAS-LVO的独立预测因素(优势比1.081,95%置信区间1.001~1.167;P=0.046)。受试者工作特征曲线分析显示,重构指数预测ICAS-LVO的曲线下面积为0.882(95%置信区间0.724~1.000;P=0.003),最佳截断值为1.1,预测敏感性和特异性分别为66.7%和100.0%。结论HRMR-VWI重构指数是ICAS-LVO的独立预测因素,重构指数≥1.1提示为ICAS-LVO。HRMR-VWI可帮助识别LVO所致AIS患者的病因,从而指导血管内治疗。

ObjectiveTo investigate the predictive value of high-resolution magnetic resonance vessel wall imaging(HRMR-VWI)features for the etiology of acute ischemic stroke(AIS)caused by intracranial large vessel occlusion(LVO).MethodsPatients diagnosed with AIS caused by LVO at the Affiliated Hospital of Yangzhou University from August 1,2019 to August 1,2022 were retrospectively collected.All patients underwent HRMR-VWI evaluation and endovascular treatment between 4.5 and 24 hours after onset.Complete recanalization of occluded vessels after direct aspiration first-pass was defined as embolic LVO,and those with residual stenosis>50%after the direct aspiration first-pass were classified as intracranial atherosclerotic stenosis related LVO(ICAS-LVO).ResultsA total of 28 patients were included.Their age was 65.32±2.23 years,20(71.4%)were males.There were 22 patients(78.6%)in the embo-LVO group and 6(21.4%)in the ICAS-LVO group.Multivariate logistic regression analysis showed that the remodeling index was an independent predictor of ICAS-LVO(odds ratio 1.081,95%confidence interval 1.001-1.167;P=0.046).The receiver operating characteristic curve analysis showed that the area under the curve of the remodeling index for predicting ICAS-LVO was 0.882(95%confidence interval 0.724-1.00;P=0.003).The optimal cutoff value was 1.1,and the predictive sensitivity and specificity were 66.7%and 100.0%,respectively.ConclusionsThe HRMR-VWI remodeling index is an independent predictor of ICAS-LVO,with a remodeling index≥1.1 indicating ICAS-LVO.HRMR-VWI can help identify the etiology of patients with AIS caused by LVO,thereby guiding endovascular treatment.