| BackgroundStroke is serious threat to the health of people all over the world,and it is also one of the most important causes of the death among Chinese people and brings enormous economic burden to the society and the family.The incidence of ischemic stroke is high,accounting for 75%to 85%of stroke patients.Internal carotid artery atherosclerosis stenosis and occlusion are the main causes of ischemic stroke.Antiplatelet aggregation drugs are still the main guidelines for internal carotid artery atherosclerotic stenosis,carotid artery stenting and carotid endarterectomy can be applied to patients with recurrent stroke attack.Besides the risk of stroke recurrence is still high despite drug treatment for patients with internal carotid artery occlusion.Other alternative treatments,such as mechanical recanalization and intracranial-extracranial artery,are still controversial.Recanalization of cerebral large vessels occlusion in acute stage can significantly reduce the mortality rate,but whether mechanical recanalization is beneficial to patients with symptomatic chronic internal carotid artery occlusion remains to be further studied.Due to the difference of collateral circulation compensation,the clinical symptoms of chronic carotid artery occlusion are quite different,which can be manifested as asymptomatic,headache,cognitive impairment,transient ischemic attack and stroke.At present,the main treatment of symptomatic chronic internal carotid artery occlusion is the conservative treatment with antiplatelet aggregation drugs,but despite the strict drug treatment,the recurrence rate of stroke in 2 years can still be as high as 22.7%[2].In recent years,mechanical recanalization has been used in the treatment of symptomatic chronic internal carotid artery occlusion more widely.Adequate preoperative imaging evaluation and strict screening of appropriate surgical cases can improve the success rate of recanalization.These vascular imaging examinations have widely used in the clinical study including:US,CT,MRI and DSA.DSA is superior to CTA and US for judging the length of the occluded vessel,the shape of the residual end of the occlusion,the condition of distal reflux and the collateral circulation compensation.But neither of these vascular imaging examination can effectively evaluate the whole blood vessel wall imaging.2D-HRMRI can evaluate the wall condition of the occlusion by multi-sequence signal and signal change before and after enhancement,but the clinical value of 2D-HRMRI is limited because 2D-HRMRI has technical limitation in scan range and thickness.As the three-dimensional HRMRI,the three-dimensional sampling perfection with application optimized contrasts using different flip angle evolutions（3D-SPACE）sequence can not only perform high-resolution imaging of the vessel wall,but also perform thin-layer scanning.The axial,sagittal and coronal images are reconstructed in any plane,and the enhancement of the occluded vessel wall is fully displayed.The research on the mechanical recanalization of the symptomatic chronic internal carotid artery occlusion under the guidance of the3D-SPACE high resolution magnetic resonance imaging has not been reported.ObjectiveThe purpose of this study was to evaluate the clinical value of 3D-SPACE high resolution magnetic resonance imaging in the mechanical recanalization of symptomatic chronic internal carotid artery occlusion to provide imaging support for improving the feasibility and safety of mechanical recanalization.MethodThis study was based on a retrospective analysis of patients with symptomatic chronic internal carotid artery occlusion diagnosed by multimode image who were acceptedintravascularmechanicalrecanalizationinDepartmentof Neuro-interventional Radiology,the First Affiliated Hospital of Zhengzhou University from January 2016 to December 2018.Image consistency of internal carotid artery occlusion between 3D-SPACE high resolution magnetic resonance imaging and microcatheter“first-pass effect”[3]was evaluate.30 patients were divided into 2 groups:3D-SPACE group and non-3D-SPACE group.The number of successful recanalization,the time of operation and the occurrence of intraoperative complications in the two groups were recorded.The patients were followed up for 1month and 3 months after operation by means of outpatient mode,inpatient mode or telephone.The neurological function status of patients was evaluated by modified Rankin Score（mRS）before operation,1 month and 3 months after operation.The data was analyzed statistically with SPSS 21.0 software.The results of this study were compared with the related home and abroad literatures to explore the safety and effectiveness of endovascular mechanical recanalization under the guidance of3D-SPACE high resolution magnetic resonance imaging in the treatment of symptomatic CICAO.ResultThis study included 30 patients（22 males and 8 females,mean age was57.73±9.18）,24 of the 30（80%）patients were successfully reopened,perioperative complication rate was 16.7%（5/30）,mean preoperative and postoperative NIHSS were 3.77±2.54 and 3.10±2.52,mean preoperative and postoperative mRS score were1.60±0.77 and 1.37±1.00.In non-3D-SPACE group,the recanalization rate was 70%（7/10）,the mean recanalization time was 110.71±10.03,the rate of perioperative complications was 20%（2/10）.The mean preoperative and postoperative NIHSS were 3.0±0.65 and 2.8±0.70,mean preoperative and postoperative mRS score were1.5±0.22 and 1.40±0.27;In the 3D-SPACE group,the successful rate of operation was 85%（17/20）,the mean recanalization time was 101.77±8.98,the incidence of perioperative complications was 15%（3/20）.The mean preoperative and postoperative NIHSS were 4.15±0.61 and 3.25±0.61,mean preoperative and postoperative mRS score were 1.65±0.18 and 1.35±0.24.The average clinical follow-up of these 24 patients with successful mechanical recanalization was9.33±6.27months,45.85%（11/24）of the patients received vascular imaging follow-up,the restenosis rate was 18.2%（2/11）.In non-3D-SPACE group:the restenosis rate was 33.3%（1/3）and the mean mRS score 3 months later operation was 1.30±0.26.In 3D-SPACE group,the restenosis rate was 12.5%（1/8）and the mean mRS score 3 months later operation was 1.05±0.20.There were no adverse events among 24 patients during follow-up of 3-24 months later operation.The data between 3D-SPACE high resolution magnetic resonance imaging and microcatheter“first-pass effect”was tested by matched sample t test.When p value was more than0.05,there was no significant difference between the two groups,which means that3D-SPACE high resolution magnetic resonance imaging has good consistency with microcatheter“first-pass effect”in the vascular route,diameter and position of occlusion.T test was used to analyze the quantitative data and Fisher exact probability method was used to analyze the qualitative data between 3D-SPACE group and non-3D-SPACE group.The p value was more than 0.05,which means that there was no significant difference in the success rate,the incidence of perioperative complications,NIHSS and mRS before and after operation between two groups.Conclusion1.Mechanical recanalization is feasible in the treatment of symptomatic chronic internal carotid artery occlusion.2.3D-SPACE high resolution magnetic resonance imaging has good consistency with microcatheter “first-pass effect” in the vascular route,diameter and position of occlusive internal carotid artery segment.3.The evaluation of chronic internal carotid artery occlusion by 3D-SPACE high resolution magnetic resonance imaging before operation can help screen suitable cases for intravascular treatment,shorten the operation time and reduce the rate of intraoperative complications.4.3D-SPACE high resolution magnetic resonance imaging can help clinicians assess the risk of surgery and choose appropriate cases carefully to increase the feasibility and safety of the operation.However,large samples and randomized controlled studies are still needed. |
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