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Abstract：
OBJECTIVE: This study aimed to identify the imaging characteristics and discriminate the etiology of acute internal carotid artery occlusion (ICAO) on computed tomography angiography (CTA) in patients with acute ischemic stroke.
METHODS: We retrospectively evaluated consecutive patients who underwent endovascular thrombectomy for acute ICAO. Contrast filling of the extracranial ICA in preprocedural CTA was considered apparent ICAO. Non-contrast filling of the extracranial ICA was evaluated according to the contrast-filled lumen configuration, lumen margin and location, Hounsfield units of the non-attenuating segment, and presence of calcification or an intimal flap. Digital subtraction angiography findings were the reference standard for ICAO etiology and the occlusion site. A diagnostic tree was derived using significant variables according to pseudo-occlusion, atherosclerotic vascular disease (ASVD), thrombotic occlusion, and dissection.
RESULTS: A total of 114 patients showed apparent ICAO (n = 21), pseudo-occlusion (n = 51), ASVD (n = 27), thrombotic occlusion (n = 9), or dissection (n = 6). Most pseudo-occlusions (50/51, 98.0%) showed dependent locations with ill-defined contrast column margins and classic flame or beak shapes. The most common occlusion site of pseudo-occlusion was the petro-cavernous ICA (n = 32, 62.7%). Apparent ICAO mainly appeared in cases with occlusion distal to the posterior communicating artery orifice. ASVD showed beak or blunt shapes in the presence of low-density plaques or dense calcifications. Dissection revealed flame- or beak-shaped appearances with circumscribed margins. Thrombotic occlusions tended to appear blunt-shaped. The decision-tree model showed a 92.5% overall accuracy.
CONCLUSIONS: CTA characteristics may help diagnose ICAO etiology. We provide a simple and easy decision-making model to inform endovascular thrombectomy.
METHODS: We retrospectively evaluated consecutive patients who underwent endovascular thrombectomy for acute ICAO. Contrast filling of the extracranial ICA in preprocedural CTA was considered apparent ICAO. Non-contrast filling of the extracranial ICA was evaluated according to the contrast-filled lumen configuration, lumen margin and location, Hounsfield units of the non-attenuating segment, and presence of calcification or an intimal flap. Digital subtraction angiography findings were the reference standard for ICAO etiology and the occlusion site. A diagnostic tree was derived using significant variables according to pseudo-occlusion, atherosclerotic vascular disease (ASVD), thrombotic occlusion, and dissection.
RESULTS: A total of 114 patients showed apparent ICAO (n = 21), pseudo-occlusion (n = 51), ASVD (n = 27), thrombotic occlusion (n = 9), or dissection (n = 6). Most pseudo-occlusions (50/51, 98.0%) showed dependent locations with ill-defined contrast column margins and classic flame or beak shapes. The most common occlusion site of pseudo-occlusion was the petro-cavernous ICA (n = 32, 62.7%). Apparent ICAO mainly appeared in cases with occlusion distal to the posterior communicating artery orifice. ASVD showed beak or blunt shapes in the presence of low-density plaques or dense calcifications. Dissection revealed flame- or beak-shaped appearances with circumscribed margins. Thrombotic occlusions tended to appear blunt-shaped. The decision-tree model showed a 92.5% overall accuracy.
CONCLUSIONS: CTA characteristics may help diagnose ICAO etiology. We provide a simple and easy decision-making model to inform endovascular thrombectomy.
摘要：
目的：本研究旨在确定急性缺血性卒中患者的CT血管造影（CTA）影像学特征并鉴别其病因。
方法：我们回顾性评估了因急性ICAO行血管内血栓切除术的连续患者。术前CTA中颅外ICA的对比填充被认为是明显的ICAO。根据造影剂填充管腔构型评估颅外ICA的非造影剂填充。管腔边缘和位置，非衰减段的亨氏单位，和钙化或内膜瓣的存在。数字减影血管造影结果是ICAO病因和闭塞部位的参考标准。根据伪遮挡，使用显著变量得出诊断树，动脉粥样硬化性血管疾病（ASVD），血栓性闭塞,和解剖。
结果：共有114例患者表现出明显的ICAO（n=21），伪遮挡（n=51），ASVD（n=27），血栓性闭塞（n=9），或解剖(n=6)。大多数假性闭塞（50/51，98.0％）显示出依赖位置，对比柱边距不明确，经典的火焰或喙形状。假性闭塞最常见的闭塞部位是海绵样ICA（n=32，62.7％）。表观ICAO主要出现在后交通动脉口远端闭塞的病例中。在存在低密度斑块或致密钙化的情况下，ASVD显示喙或钝形。解剖显示火焰状或喙状外观，边缘有限。血栓闭塞倾向于呈钝形。决策树模型显示出92.5%的总体准确率。
结论：CTA特征可能有助于诊断ICAO病因。我们提供了一个简单易行的决策模型来告知血管内血栓切除术。
方法：我们回顾性评估了因急性ICAO行血管内血栓切除术的连续患者。术前CTA中颅外ICA的对比填充被认为是明显的ICAO。根据造影剂填充管腔构型评估颅外ICA的非造影剂填充。管腔边缘和位置，非衰减段的亨氏单位，和钙化或内膜瓣的存在。数字减影血管造影结果是ICAO病因和闭塞部位的参考标准。根据伪遮挡，使用显著变量得出诊断树，动脉粥样硬化性血管疾病（ASVD），血栓性闭塞,和解剖。
结果：共有114例患者表现出明显的ICAO（n=21），伪遮挡（n=51），ASVD（n=27），血栓性闭塞（n=9），或解剖(n=6)。大多数假性闭塞（50/51，98.0％）显示出依赖位置，对比柱边距不明确，经典的火焰或喙形状。假性闭塞最常见的闭塞部位是海绵样ICA（n=32，62.7％）。表观ICAO主要出现在后交通动脉口远端闭塞的病例中。在存在低密度斑块或致密钙化的情况下，ASVD显示喙或钝形。解剖显示火焰状或喙状外观，边缘有限。血栓闭塞倾向于呈钝形。决策树模型显示出92.5%的总体准确率。
结论：CTA特征可能有助于诊断ICAO病因。我们提供了一个简单易行的决策模型来告知血管内血栓切除术。
