Occluson Pattern in Circle of Willis: Prognostic Marker for Endovascular Treatment in Acute Carotid Terminus Occlusion

Background & OBJECTIVES: Although the recent progress in acute ischemic stroke treatment, carotid terminus occlusion (CTO) is quite demanding to recanalize, and even if it is achieved, the morbidity and mortality rates remain high. In this study, we aimed to discover a prognostic marker for acute CTO, thereby selectively sorting out patients who are not worthwhile for further endovascular treatment. METHODS: This is a retrospective study by reviewing our prospectively registered database of acute ischemic stroke patients from March 2006 to July 2013. Consecutive patients with acute symptomatic CTO within 6 hours, who underwent endovascular treatment were included. We investigated the baseline configuration of circle of Willis and the occlusion pattern of each cerebral artery and divided patients into middle cerebral artery (MCA) only group and MCA plus group by CT angiography. Patients in MCA only group had only MCA occlusion whereas those in MCA plus group had other major intracranial artery occlusion such as ipsilateral A2, P2, or contralateral A2 resulting from CTO. Baseline demographics, characteristics and clinical/radiologic outcomes were compared. Poor prognosis was defined as modified Rankin Scale (mRS) 5 and 6 at 3 months. We evaluated whether MCA plus group would be a ‘stop sign’ of further endovascular treatment for acute CTO by analyzing logistic regression model and receiver operating characteristic (ROC) curve. RESULTS: Of 54 patients, 33 patients were included in MCA only group, while 21 patients were grouped as MCA plus group. Age (72.6±11.0 vs 66.1±13.2, p=0.066) and median NIHSS score at presentation [16 (14–18)vs 19 (18–22), p=0.006) were higher in the MCA plus group than the only group. Frequency of male gender and cardioembolic source did not differ. Successful reperfusion was achieved higher in MCA-only group [Thrombolysis in Cerebral infarction (TICI) classification 2b–3 14/33 (42.4%) vs. 3/21 (14.3%), p=0.030]. Patients in MCA only group had significantly better prognosis than MCA-plus (p=0.001). The MCA plus was proven as an independent predictor for poor prognosis at 3 months when age and sex, and initial NIHSS score were adjusted (OR 8.62; 95% CI 1.11- 66.64, p=0.039). Based on our findings, we made a formulanamed as CTO score to predict poor prognosis in acute CTO patients, with occlusion pattern of MCAplus, age and initial NIHSS based on the beta value of the logistic regression model. The area under the ROC curve for the formula was 0.794. CONCLUSION: Detection and characterization of collateral status is mandatory but of limit in acute CTO. Assessment of the configuration and patency of CoW may be non-invasive, practical and time-saving method to estimate the collateral status in CTO, hence be applicable to guide acute therapeutic intervention. CTO score can be utilized as a valuable early indicator of prognosis in acute CTO.

Author dc:creator

• 이, 선욱

Contributors dc:contributor

• 이, 진수
• 대학원 의학과
• 201224112

• cerebral infarction
• carotid terminus occlusion
• carotid artery
• thrombosis
• endovascular procedures
• circle of Willis
• 허혈성뇌졸중
• 내경동맥말단부폐색
• 내경동맥혈전증
• 재개통치료
• 윌리스고리

Language dc:language

en

Identifier

http://dcoll.ajou.ac.kr:9080/dcollection/jsp/common/DcLoOrgPer.jsp?sItemId=000000016082
000000016082

OAI identifier oai:identifier

oai:repository.ajou.ac.kr:201003/10897