Intracranial Artery Calcifications Profile as a Predictor of Recanalization Failure in Endovascular Stroke Treatment
Rodrigo-Gisbert, Marc (Hospital Universitari Vall d'Hebron)
Requena, Manuel (Hospital Universitari Vall d'Hebron)
Rubiera Del Fueyo, Marta A (Universitat Autònoma de Barcelona. Departament de Medicina)
Khalife, Jane (Cooper University Hospital (Camden, Estats Units d'Amèrica))
Lozano, Prudencio (Hospital Universitari Vall d'Hebron)
De Dios Lascuevas, Marta (Hospital Universitari Vall d'Hebron)
García-Tornel, Álvaro (Hospital Universitari Vall d'Hebron)
Olivé-Gadea, Marta (Hospital Universitari Vall d'Hebron)
Piñana, Carlos (Hospital Universitari Vall d'Hebron)
Rizzo, Federica (Hospital Universitari Vall d'Hebron)
Boned, Sandra (Hospital Universitari Vall d'Hebron)
Muchada, Marian (Hospital Universitari Vall d'Hebron)
Rodriguez-Villatoro, Noelia (Hospital Universitari Vall d'Hebron)
Rodriguez-Luna, David (Hospital Universitari Vall d'Hebron)
Juega, Jesus (Hospital Universitari Vall d'Hebron)
Pagola, Jorge (Hospital Universitari Vall d'Hebron)
Hernández Morales, David (Hospital Universitari Vall d'Hebron)
Molina, Carlos A. (Hospital Universitari Vall d'Hebron)
Tomasello, Alejandro (Hospital Universitari Vall d'Hebron)
Ribo, Marc (Hospital Universitari Vall d'Hebron)

Fecha:	2023
Resumen:	Background: Acute ischemic stroke with large or medium-vessel occlusion associated with intracranial artery calcification (IAC) is an infrequent phenomenon presumably associated with intracranial atherosclerotic disease. We aimed to characterize IAC and its impact on endovascular treatment outcomes. Methods: We performed a retrospective cross-sectional study of consecutive patients with stroke treated with thrombectomy from January 2020 to July 2021 in our institution. We described IAC findings (length, density, and location pattern) on baseline noncontrast computed tomography. Patients were divided into 3 groups: IAC related to the occlu sion location (symptomatic-IAC group), unrelated to the occlusion (asymptomatic-IAC group), and absence of any IAC (non-IAC group). We analyzed the association between the IAC profile and outcomes using logistic regression models. Intracranial angioplasty and stenting were considered rescue treatments. Results: Of the 393 patients included, 26 (6. 6%) patients presented a symptomatic-IAC, 77 (19. 6%) patients an asymptomatic-IAC, and in 290 (73. 8%) patients no IAC was observed. The rate of failed recanalization (expanded Thrombolysis in Cerebral Infarction 0-2a) before rescue treatment was higher in symptomatic-IAC (65. 4%) than in asymptomatic-IAC (15. 6%; P<0. 001) or non-IAC (13. 4%; P<0. 001). Rescue procedures were more frequently performed in symptomatic-IAC (26. 9%) than in asymptomatic-IAC (1. 3%; P<0. 001) and non-IAC (4. 1%; P<0. 001). After adjusting for identifiable clinical and radiological confounders, symptomatic-IAC emerged as an independent predictor of failed recanalization (odds ratio, 11. 89 [95% CI, 3. 94-35. 91]; P<0. 001), adoption of rescue procedures (odds ratio, 12. 38 [95% CI, 2. 22-69. 09]; P=0. 004), and poor functional outcome (90-day modified Rankin Scale score ≥3; odds ratio, 3. 51 [95% CI, 1. 02-12. 00]; P=0. 046). Conclusions: The presence of IAC related to the occlusion location is associated with worse angiographic and functional outcomes. Therefore, identification of symptomatic-IAC on baseline imaging may guide optimal endovascular treatment strategy, predicting the need for intracranial stenting and angioplasty.
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Lengua:	Anglès
Documento:	Article ; recerca ; Versió acceptada per publicar
Materia:	CT scan ; Intracranial Artery Calcifications ; Intracranial Atherosclerotic Disease ; Endovascular Treatment
Publicado en:	Stroke, Vol. 54 Núm. 2 (february 2023) , p. 430-438, ISSN 1524-4628

DOI: 10.1161/STROKEAHA.122.041257

Postprint 28 p, 333.5 KB

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