Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Neurology
Published in: BMC Neurology 1/2023

Open Access 01-12-2023 | Research

Predictors of successful endovascular recanalization in patients with symptomatic nonacute intracranial large artery occlusion

Authors: Shuo Yan, Hao Feng, Lin Ma, Ji-Chong Xu, Hong-Jie Han, Hong-En Huang, Hua-Qiao Tan, Chun Fang

Published in: BMC Neurology | Issue 1/2023

Login to get access

Abstract

Background

Endovascular recanalization in patients with symptomatic nonacute intracranial large artery occlusion (ILAO) has been reported to be feasible, but technically challenging. This study aimed to determine the predictors of successful endovascular recanalization in patients with symptomatic nonacute ILAO.

Methods

The outcomes of endovascular recanalization attempts performed in 70 consecutive patients showing symptomatic nonacute ILAO with hemodynamic cerebral ischemia between January 2016 to December 2022 were reviewed. Potential variables, including clinical and radiological characteristics related to technical success, were collected. Univariate analysis and multivariate logistic regression were performed to identify predictors of successful recanalization for nonacute ILAO.

Results

Technically successful recanalization was achieved in 57 patients (81.4%). The periprocedural complication rate was 21.4% (15 of 70), and the overall 30-day morbidity and mortality rates were 7.1% (5 of 70) and 2.9% (2 of 70), respectively. Univariate analysis showed that successful recanalization was associated with occlusion duration, stump morphology, occlusion length, slow distal antegrade flow sign, and the presence of bridging collateral vessels. Multivariate analysis showed that occlusion duration ≤ 3 months (odds ratio [OR]: 22.529; 95% confidence interval [CI]: 1.636-310.141), tapered stump (OR: 7.498; 95% CI: 1.533–36.671), and occlusion length < 10 mm (OR: 7.049; 95% CI: 1.402–35.441) were independent predictive factors for technical success of recanalization.

Conclusions

Occlusion duration ≤ 3 months, tapered stump, and occlusion length < 10 mm were independent positive predictors of technical success of endovascular recanalization for symptomatic nonacute ILAO. These findings may help predict the likelihood of successful recanalization in patients with symptomatic nonacute ILAO and also provide a reference for the selection of appropriate patients. Further prospective and multicenter studies are required to validate our findings.
Literature
1.
Gorelick PB, Wong KS, Bae HJ, Pandey DK. Large artery intracranial occlusive disease: a large worldwide burden but a relatively neglected frontier. Stroke. 2008;39(8):2396–9.PubMed
2.
Smith WS, Lev MH, English JD, Camargo EC, Chou M, Johnston SC, et al. Significance of large vessel intracranial occlusion causing acute ischemic stroke and TIA. Stroke. 2009;40(12):3834–40.PubMedPubMedCentral
3.
Yamauchi H, Higashi T, Kagawa S, Kishibe Y, Takahashi M. Chronic hemodynamic compromise and cerebral ischemic events in asymptomatic or remote symptomatic large-artery intracranial occlusive disease. AJNR Am J Neuroradiol. 2013;34(9):1704–10.PubMedPubMedCentral
4.
Kuroda S, Houkin K, Kamiyama H, Mitsumori K, Iwasaki Y, Abe H. Long-term prognosis of medically treated patients with internal carotid or middle cerebral artery occlusion: can acetazolamide test predict it? Stroke. 2001;32(9):2110–6.PubMed
5.
Group EIBS. Failure of extracranial-intracranial arterial bypass to reduce the risk of ischemic stroke. Results of an international randomized trial. N Engl J Med. 1985;313(19):1191–200.
6.
Powers WJ, Clarke WR, Grubb RL Jr., Videen TO, Adams HP Jr., Derdeyn CP, et al. Extracranial-intracranial bypass surgery for stroke prevention in hemodynamic cerebral ischemia: the carotid occlusion surgery study randomized trial. JAMA. 2011;306(18):1983–92.PubMedPubMedCentral
7.
Yu Jia Z, Sun Song Y, Jon Sheen J, Goo Kim J, Hee Lee D. Endovascular recanalization of symptomatic non-acute intracranial artery occlusion: procedural and mid-term clinical outcomes in the anterior circulation. Interv Neuroradiol. 2019;25(4):380–9.PubMedPubMedCentral
8.
Ma L, Liu YH, Feng H, Xu JC, Yan S, Han HJ, et al. Endovascular recanalization for symptomatic subacute and chronic intracranial large artery occlusion of the anterior circulation: initial experience and technical considerations. Neuroradiology. 2019;61(7):833–42.PubMed
9.
Aghaebrahim A, Jovin T, Jadhav AP, Noorian A, Gupta R, Nogueira RG. Endovascular recanalization of complete subacute to chronic atherosclerotic occlusions of intracranial arteries. J Neurointerv Surg. 2014;6(9):645–8.PubMed
10.
Zheng M, Song Y, Zhang J, Zhao W, Sun L, Yin H, et al. Endovascular recanalization of non-acute symptomatic middle cerebral artery total occlusion and its short-term outcomes. Front Neurol. 2019;10:484.PubMedPubMedCentral
11.
Yao YD, Liu AF, Qiu HC, Zhou J, Li C, Wang Q, et al. Outcomes of late endovascular recanalization for symptomatic non-acute atherosclerotic intracranial large artery occlusion. Clin Neurol Neurosurg. 2019;187:105567.PubMed
12.
Gao P, Wang Y, Ma Y, Yang Q, Song H, Chen Y, et al. Endovascular recanalization for chronic symptomatic intracranial vertebral artery total occlusion: experience of a single center and review of literature. J Neuroradiol. 2018;45(5):295–304.PubMed
13.
Zhao W, Zhang J, Meng Y, Zhang Y, Zhang J, Song Y, et al. Symptomatic atherosclerotic non-acute intracranial vertebral artery total occlusion: clinical features, imaging characteristics, endovascular recanalization, and follow-up outcomes. Front Neurol. 2020;11:598795.PubMedPubMedCentral
14.
Dashti SR, Park MS, Stiefel MF, McDougall CG, Albuquerque FC. Endovascular recanalization of the subacute to chronically occluded basilar artery: initial experience and technical considerations. Neurosurgery. 2010;66(4):825–31. discussion 31 – 2.PubMed
15.
He Y, Wang Z, Li T, Jiang WJ, Zhu L, Xue J, et al. Preliminary findings of recanalization and stenting for symptomatic vertebrobasilar artery occlusion lasting more than 24 h: a retrospective analysis of 21 cases. Eur J Radiol. 2013;82(9):1481–6.PubMed
16.
Kang K, Yang B, Gong X, Chen X, Gu W, Ma G, et al. Cerebral hemodynamic changes after endovascular recanalization of symptomatic chronic intracranial artery occlusion. Front Neurol. 2020;11:318.PubMedPubMedCentral
17.
He Y, Bai W, Li T, Xue J, Wang Z, Zhu L, et al. Perioperative complications of recanalization and stenting for symptomatic nonacute vertebrobasilar artery occlusion. Ann Vasc Surg. 2014;28(2):386–93.PubMed
18.
Gao F, Guo X, Han J, Sun X, Zhou Z, Miao Z. Endovascular recanalization for symptomatic non-acute middle cerebral artery occlusion: proposal of a new angiographic classification. J Neurointerv Surg. 2021;13(10):900–5.PubMed
19.
Gao F, Han J, Guo X, Sun X, Ma N, Miao Z. Endovascular recanalization for non-acute basilar artery occlusions with progressive or recurrent ischemic symptoms: a multicenter clinical experience. J Neurointerv Surg. 2022;14(2):133–7.PubMed
20.
Gao F, Guo X, Sun X, Liu Y, Wu Y, Miao Z. Dual-roadmap guidance for endovascular recanalization of medically refractory non-acute intracranial arterial occlusions: consecutive multicenter series and technical review. J Neurointerv Surg. 2021;13(10):889–93.PubMed
21.
Gao F, Sun X, Guo X, Li D, Xu GD, Miao ZR. Endovascular recanalization of symptomatic nonacute Intracranial Internal Carotid artery occlusion: proposal of a New Angiographic classification. AJNR Am J Neuroradiol. 2021;42(2):299–305.PubMedPubMedCentral
22.
Hou Z, Yan L, Zhang Z, Jing J, Lyu J, Hui FK et al. High-resolution magnetic resonance vessel wall imaging-guided endovascular recanalization for nonacute intracranial artery occlusion. J Neurosurg. 2021:1–7.
23.
Gao F, Sun X, Zhang H, Ma N, Mo D, Miao Z. Endovascular recanalization for Nonacute Intracranial vertebral artery occlusion according to a new classification. Stroke. 2020;51(11):3340–3.PubMed
24.
Chao L, Qingbin M, Haowen X, Shanshan X, Qichang F, Zhen C, et al. Imaging predictors for endovascular recanalization of non-acute occlusion of Internal Carotid Artery based on 3D T1-SPACE MRI and DSA. Front Neurol. 2021;12:692128.PubMedPubMedCentral
25.
Chen YH, Leong WS, Lin MS, Huang CC, Hung CS, Li HY, et al. Predictors for successful endovascular intervention in chronic carotid artery total occlusion. JACC Cardiovasc Interv. 2016;9(17):1825–32.PubMed
26.
Yang B, Kang K, Gao F, Mo D, Tong X, Song L et al. Association of occlusion time with successful endovascular recanalization in patients with symptomatic chronic intracranial total occlusion. J Neurosurg. 2022:1–10.
27.
Bouthillier A, van Loveren HR, Keller JT. Segments of the internal carotid artery: a new classification. Neurosurgery. 1996;38(3):425–32. discussion 32 – 3.PubMed
28.
Seners P, Baron JC. Revisiting ‘progressive stroke’: incidence, predictors, pathophysiology, and management of unexplained early neurological deterioration following acute ischemic stroke. J Neurol. 2018;265(1):216–25.PubMed
29.
Higashida RT, Furlan AJ, Roberts H, Tomsick T, Connors B, Barr J, et al. Trial design and reporting standards for intra-arterial cerebral thrombolysis for acute ischemic stroke. Stroke. 2003;34(8):e109–37.PubMed
30.
Sun X, Tong X, Lo WT, Mo D, Gao F, Ma N, et al. Risk factors of subacute thrombosis after intracranial stenting for symptomatic intracranial arterial stenosis. Stroke. 2017;48(3):784–6.PubMed
31.
Furie KL, Kasner SE, Adams RJ, Albers GW, Bush RL, Fagan SC, et al. Guidelines for the prevention of stroke in patients with stroke or transient ischemic attack: a guideline for healthcare professionals from the american heart association/american stroke association. Stroke. 2011;42(1):227–76.PubMed
32.
Chimowitz MI, Lynn MJ, Derdeyn CP, Turan TN, Fiorella D, Lane BF, et al. Stenting versus aggressive medical therapy for intracranial arterial stenosis. N Engl J Med. 2011;365(11):993–1003.PubMedPubMedCentral
33.
Morino Y, Abe M, Morimoto T, Kimura T, Hayashi Y, Muramatsu T, et al. Predicting successful guidewire crossing through chronic total occlusion of native coronary lesions within 30 minutes: the J-CTO (Multicenter CTO Registry in Japan) score as a difficulty grading and time assessment tool. JACC Cardiovasc Interv. 2011;4(2):213–21.PubMed
34.
Christoforidis GA, Mohammad Y, Avutu B, Tejada A, Slivka AP. Arteriographic demonstration of slow antegrade opacification distal to a cerebrovascular thromboembolic occlusion site as a favorable indicator for intra-arterial thrombolysis. AJNR Am J Neuroradiol. 2006;27(7):1528–31.PubMedPubMedCentral
35.
Puma JA, Sketch MH Jr., Tcheng JE, Harrington RA, Phillips HR, Stack RS, et al. Percutaneous revascularization of chronic coronary occlusions: an overview. J Am Coll Cardiol. 1995;26(1):1–11.PubMed
36.
Li M, Zhang J, Pan J, Lu Z. Obstructive coronary artery disease: reverse attenuation gradient sign at CT indicates distal retrograde flow–a useful sign for differentiating chronic total occlusion from subtotal occlusion. Radiology. 2013;266(3):766–72.PubMed
37.
Tan KH, Sulke N, Taub NA, Watts E, Karani S, Sowton E. Determinants of success of coronary angioplasty in patients with a chronic total occlusion: a multiple logistic regression model to improve selection of patients. Br Heart J. 1993;70(2):126–31.PubMedPubMedCentral
38.
Salarifar M, Mousavi MR, Saroukhani S, Nematipour E, Kassaian SE, Alidoosti M, et al. Percutaneous coronary intervention to treat chronic total occlusion: predictors of technical success and one-year clinical outcome. Tex Heart Inst J. 2014;41(1):40–7.PubMedPubMedCentral
39.
Oktaviono YH, Rizal A, Al-Farabi MJ, Maghfirah I, Rachmi DA. Coronary angiography characteristics as predictor of successful chronic total occlusion recanalization. Int J Angiol. 2020;29(3):196–201.PubMedPubMedCentral
40.
Namazi MH, Serati AR, Vakili H, Safi M, Parsa SAP, Saadat H, et al. A novel risk score in Predicting failure or success for Antegrade Approach to Percutaneous Coronary intervention of chronic total occlusion: Antegrade CTO score. Int J Angiol. 2017;26(2):89–94.PubMed
41.
Alessandrino G, Chevalier B, Lefevre T, Sanguineti F, Garot P, Unterseeh T, et al. A clinical and angiographic Scoring System to predict the probability of successful first-attempt percutaneous coronary intervention in patients with total chronic coronary occlusion. JACC Cardiovasc Interv. 2015;8(12):1540–8.PubMed
42.
Wang N, Fulcher J, Abeysuriya N, Adams M, Lal S. Predictors of successful chronic total occlusion percutaneous coronary interventions: a systematic review and meta-analysis. Heart. 2018;104(6):517–24.PubMed
43.
Katsuragawa M, Fujiwara H, Miyamae M, Sasayama S. Histologic studies in percutaneous transluminal coronary angioplasty for chronic total occlusion: comparison of tapering and abrupt types of occlusion and short and long occluded segments. J Am Coll Cardiol. 1993;21(3):604–11.PubMed
44.
Barger AC, Beeuwkes R 3rd, Lainey LL, Silverman KJ. Hypothesis: vasa vasorum and neovascularization of human coronary arteries. A possible role in the pathophysiology of atherosclerosis. N Engl J Med. 1984;310(3):175–7.
45.
Liang W, Wang Y, Du Z, Mang J, Wang J. Intraprocedural angiographic signs observed during endovascular thrombectomy in patients with Acute ischemic stroke: a systematic review. Neurology. 2021;96(23):1080–90.PubMed
Metadata
Title
Predictors of successful endovascular recanalization in patients with symptomatic nonacute intracranial large artery occlusion
Authors
Shuo Yan
Hao Feng
Lin Ma
Ji-Chong Xu
Hong-Jie Han
Hong-En Huang
Hua-Qiao Tan
Chun Fang
Publication date
01-12-2023
Publisher
BioMed Central
Published in
BMC Neurology / Issue 1/2023
Electronic ISSN: 1471-2377
DOI
https://doi.org/10.1186/s12883-023-03424-y

Other articles of this Issue 1/2023

BMC Neurology 1/2023 Go to the issue

Case Report

Intractable hiccups after VNS implantation

Case report

Ischemic optic neuropathy as first presentation in patient with m.3243 A > G MELAS classic mutation

Research

Seizure control during pregnancy and postpartum period in women with epilepsy: an Egyptian prospective study

Research

Stroke epidemiology and outcomes of stroke patients in Nepal: a systematic review and meta-analysis

Research

Functional connectivity of the language area in migraine: a preliminary classification model

Case Report

Autoimmune glial fibrillary acidic protein astrocytopathy associated with breast cancer: a case report