Clinico-radiological features of intracranial atherosclerosis-related large vessel occlusion prior to endovascular treatment
Rodrigo-Gisbert, Marc (Universitat Autònoma de Barcelona. Departament de Medicina)
García-Tornel, Álvaro (Universitat Autònoma de Barcelona. Departament de Medicina)
Requena, Manuel (Hospital Universitari Vall d'Hebron)
Vielba-Gómez, Isabel (Hospital Universitari de Girona Doctor Josep Trueta)
Bashir, Saima (Hospital Universitari de Girona Doctor Josep Trueta)
Rubiera Del Fueyo, Marta A (Universitat Autònoma de Barcelona. Departament de Medicina)
De Dios Lascuevas, Marta (Hospital Universitari Vall d'Hebron)
Olivé-Gadea, Marta (Universitat Autònoma de Barcelona. Departament de Medicina)
Piñana, Carlos (Hospital Universitari Vall d'Hebron)
Rizzo, Federica (Universitat Autònoma de Barcelona. Departament de Medicina)
Muchada, Marian (Universitat Autònoma de Barcelona. Departament de Medicina)
Rodriguez-Villatoro, Noelia (Universitat Autònoma de Barcelona. Departament de Medicina)
Rodriguez-Luna, David (Universitat Autònoma de Barcelona. Departament de Medicina)
Juega, Jesus (Universitat Autònoma de Barcelona. Departament de Medicina)
Pagola, Jorge (Universitat Autònoma de Barcelona. Departament de Medicina)
Hernández Morales, David (Hospital Universitari Vall d'Hebron)
Molina, Carlos A. (Universitat Autònoma de Barcelona. Departament de Medicina)
Terceño, Mikel (Hospital Universitari de Girona Doctor Josep Trueta)
Tomasello, Alejandro (Hospital Universitari Vall d'Hebron)
Ribo, Marc (Universitat Autònoma de Barcelona. Departament de Medicina)

Fecha:	2024
Resumen:	The identification of large vessel occlusion with underlying intracranial atherosclerotic disease (ICAS-LVO) before endovascular treatment (EVT) continues to be a challenge. We aimed to analyze baseline clinical-radiological features associated with ICAS-LVO that could lead to a prompt identification. We performed a retrospective cross-sectional study of consecutive patients with stroke treated with EVT from January 2020 to April 2022. We included anterior LVO involving intracranial internal carotid artery and middle cerebral artery. We analyzed baseline clinical and radiological variables associated with ICAS-LVO and evaluated the diagnostic value of a multivariate logistic regression model to identify ICAS-LVO before EVT. ICAS-LVO was defined as presence of angiographic residual stenosis or a trend to re-occlusion during EVT procedure. A total of 338 patients were included in the study. Of them, 28 patients (8. 3%) presented with ICAS-LVO. After adjusting for confounders, absence of atrial fibrillation (OR 9. 33, 95% CI 1. 11-78. 42; p = 0. 040), lower hypoperfusion intensity ratio (HIR [Tmax > 10 s/Tmax > 6 s ratio], (OR 0. 69, 95% CI 0. 50-0. 95; p = 0. 025), symptomatic intracranial artery calcification (IAC, OR. 15, 95% CI 1. 64-26. 42, p = 0. 006), a more proximal occlusion (ICA, MCA-M1: OR 4. 00, 95% CI 1. 23-13. 03; p = 0. 021), and smoking (OR 2. 91, 95% CI 1. 08-7. 90; p = 0. 035) were associated with ICAS-LVO. The clinico-radiological model showed an overall well capability to identify ICAS-LVO (AUC = 0. 88, 95% CI 0. 83-0. 94; p < 0. 001). In conclusion, a combination of clinical and radiological features available before EVT can help to identify an ICAS-LVO. This approach could be useful to perform a rapid assessment of underlying etiology and suggest specific pathophysiology-based measures. Prospective studies are needed to validate these findings in other populations.
Derechos:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Lengua:	Anglès
Documento:	Article ; recerca ; Versió publicada
Materia:	Neuroscience ; Neurology ; Stroke
Publicado en:	Scientific reports, Vol. 14 (february 2024) , ISSN 2045-2322

DOI: 10.1038/s41598-024-53354-z
PMID: 38316891

9 p, 1.5 MB

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