Abstract：
Studies on changes in the distal internal carotid artery based on high resolution magnetic resonance imaging (HRMRI) are scarce. Herein, we propose a histological classification system for patients with carotid artery pseudo-occlusion or occlusion based on preoperative HRMRI, for which we evaluated the feasibility and clinical implications.
From January 2017 to June 2021, 40 patients with Doppler ultrasound, CTA or MRA suggesting carotid artery occlusion were enrolled in this study. A new classification system based on HRMRI was established and subsequently verified by postoperative specimens. We recorded and analyzed patient characteristics, HRMRI data, recanalization rate, requirements of additional endovascular procedures, complications, and outcomes.
Four histological classifications (type Ⅰ-Ⅳ) were identified. According to our classification system, 20 patients (50.00%) were type I, nine (22.50%) were type II, 7 (17.50%) were type III, and four (10.00%) were type Ⅳ. The success rate of recanalization was 88.89% (32/36) in type I-III patients. Four (44.44%) type Ⅱ patients and five (71.43%) type Ⅲ patients suffered from intraoperative dissection.
Patients identified as types I (pseudo-occlusion) and II (thrombotic-occlusion) were able to be treated via hybrid revascularization with relatively low risk, while patients identified as type III (fibrous-occlusion) required more careful treatment. Recanalization is not suitable for patients identified as type Ⅳ. Our proposed classification system based on HRMRI data can be used as an adjunctive guide to predict the technical feasibility and success of revascularization via a hybrid technique.
From January 2017 to June 2021, 40 patients with Doppler ultrasound, CTA or MRA suggesting carotid artery occlusion were enrolled in this study. A new classification system based on HRMRI was established and subsequently verified by postoperative specimens. We recorded and analyzed patient characteristics, HRMRI data, recanalization rate, requirements of additional endovascular procedures, complications, and outcomes.
Four histological classifications (type Ⅰ-Ⅳ) were identified. According to our classification system, 20 patients (50.00%) were type I, nine (22.50%) were type II, 7 (17.50%) were type III, and four (10.00%) were type Ⅳ. The success rate of recanalization was 88.89% (32/36) in type I-III patients. Four (44.44%) type Ⅱ patients and five (71.43%) type Ⅲ patients suffered from intraoperative dissection.
Patients identified as types I (pseudo-occlusion) and II (thrombotic-occlusion) were able to be treated via hybrid revascularization with relatively low risk, while patients identified as type III (fibrous-occlusion) required more careful treatment. Recanalization is not suitable for patients identified as type Ⅳ. Our proposed classification system based on HRMRI data can be used as an adjunctive guide to predict the technical feasibility and success of revascularization via a hybrid technique.
摘要：
目的：基于高分辨率磁共振成像（HRMRI）对颈内动脉远端变化的研究很少。在这里，我们提出了一种基于术前HRMRI的颈动脉假性闭塞或闭塞患者的组织学分类系统，为此，我们评估了可行性和临床意义。
方法：2017年1月至2021年6月，40例多普勒超声患者，提示颈动脉闭塞的CTA或MRA纳入本研究。建立了基于HRMRI的新分类系统，随后通过术后标本进行了验证。我们记录并分析了患者的特征，HRMRI数据,再通率，额外血管内手术的要求，并发症,和结果。
结果：确定了四种组织学分类（Ⅰ-Ⅳ型）。根据我们的分类系统，20例(50.00%)为I型,9人(22.50%)为II型，7（17.50%）为III型，其中4例(10.00%)为Ⅳ型。Ⅰ-Ⅲ型患者再通成功率为88.89%(32/36)。4例(44.44%)Ⅱ型患者和5例(71.43%)Ⅲ型患者发生术中夹层。
结论：被确定为I型（假性闭塞）和II型（血栓性闭塞）的患者能够通过混合血运重建治疗，风险相对较低。而确定为III型（纤维性闭塞）的患者需要更仔细的治疗。再通不适用于确定为Ⅳ型的患者。我们提出的基于HRMRI数据的分类系统可用作辅助指南，以预测通过混合技术进行血运重建的技术可行性和成功性。
方法：2017年1月至2021年6月，40例多普勒超声患者，提示颈动脉闭塞的CTA或MRA纳入本研究。建立了基于HRMRI的新分类系统，随后通过术后标本进行了验证。我们记录并分析了患者的特征，HRMRI数据,再通率，额外血管内手术的要求，并发症,和结果。
结果：确定了四种组织学分类（Ⅰ-Ⅳ型）。根据我们的分类系统，20例(50.00%)为I型,9人(22.50%)为II型，7（17.50%）为III型，其中4例(10.00%)为Ⅳ型。Ⅰ-Ⅲ型患者再通成功率为88.89%(32/36)。4例(44.44%)Ⅱ型患者和5例(71.43%)Ⅲ型患者发生术中夹层。
结论：被确定为I型（假性闭塞）和II型（血栓性闭塞）的患者能够通过混合血运重建治疗，风险相对较低。而确定为III型（纤维性闭塞）的患者需要更仔细的治疗。再通不适用于确定为Ⅳ型的患者。我们提出的基于HRMRI数据的分类系统可用作辅助指南，以预测通过混合技术进行血运重建的技术可行性和成功性。
