Article Figures & Data
Figures
- FIG 1.
A–C, T2WI, T1WI, and CE-T1WI show the measurement of the proximal segment; the loose matrix (purple) shows hyperintensity on T2WI, iso- or hypointensity on T1WI, and enhancement on CE-T1WI. Calcification (blue) appears as hypointensity on all sequences; hemorrhage (orange) appears as hyperintensity on T1WI, iso- or hypointensity on T2WI, and no enhancement on CE-T1WI. The lipid-rich necrotic core (yellow) shows iso- or hyperintensity on T1WI, iso- or hyperintensity on T2WI, and enhancement on CE-T1WI. D, The lumen and wall area were measured in the distal occlusion.
- FIG 2.
Successful recanalization cases. A, Curved planar reformation (CPR) on T1WI-volume isotropic turbo spin-echo acquisition (VISTA) shows moderate hypointensity in the proximal occlusion and iso- or hypointensity in the lumen of the distal occlusion. B, CPR on T1WI-VISTA-CE shows inhomogeneous enhancement in the origin of the left ICA and hypointensity in the distal occlusion. C and D, CE-MRA and preoperative DSA show a tapered stump (triangle) and reversal of flow above the clinoid segment of left ICA (arrow). E and F, Postoperative DSA shows successful recanalization. G–I, Plaque composition is shown in the proximal occlusion on T1WI and T2WI and enhancement on T1WI (blue, calcification; orange, hemorrhage; yellow, lipid-rich/necrotic core; purple, loose matrix).
- FIG 3.
Unsuccessful recanalization cases. A, Curved planar reformation (CPR) on T1WI-volume isotropic turbo spin-echo acquisition (VISTA) shows mixed signal and wall collapse in the lumen distal to the occlusion. B, CPR on T1WI-VISTA-CE shows inhomogeneous enhancement in the proximal occlusion and distal segment of the right ICA (arrowhead). C–E, CE-MRA and DSA show a blunt stump (triangle), secondary collateral circulation (arrowhead), and reversal flow above the communicating segment of right ICA (arrows). F–H, Plaque composition is shown in the proximal occlusion (blue, calcification; orange, hemorrhage; yellow, lipid-rich/necrotic core; purple, loose matrix).
Tables
Successful (n = 76) Unsuccessful (n = 38) P Age (mean) (yr) 53.9 (SD, 15.9) 58.5 (SD, 11.0) .115 Male (No.) (%) 49 (64.5) 23 (60.5) .680 Smoking (No.) (%) 44 (57.9) 26 (68.4) .276 Hypertension (No.) (%) 29 (38.1) 14 (36.8) .891 Diabetes mellitus (No.) (%) 22 (28.9) 5 (13.2) .062 Hyperlipidemia (No.) (%) 39 (51.3) 15 (39.5) .233 History of stroke (No.) (%) 12 (15.8) 8 (21.1) .500 Stroke (No.) (%) 55 (72.4) 32 (84.2) .161 Total (n = 114) Successful (n = 76) Unsuccessful (n = 38) P Right (No.) (%) 67 (58.8) 42 (55.2) 25 (65.8) .282 Tapered stump (No.) (%) 64 (56.1) 48 (63.2) 16 (42.1) .033 Level of reversed distal ICA flow <.001 Communicating segment (No.) (%) 8 (7.0) 2 (2.6) 6 (15.8) Ophthalmic segment (No.) (%) 12 (10.5) 2 (2.6) 10 (26.3) Clinoid segment (No.) (%) 23 (20.2) 14 (18.4) 9 (23.7) Cavernous segment (No.) (%) 32 (28.1) 24 (31.6) 8 (21.1) Petrous segment or below (No.) (%) 39 (34.2) 34 (44.7) 5 (13.2) Collateral circulation Primary (No.) (%) 64 (56.1) 39 (51.3) 25 (65.8) .142 Secondary (No.) (%) 25 (21.9) 12 (15.7) 13 (34.2) .025 Proximal occlusion Lesion length (mean) (mm) 21.9 (SD, 4.2) 20.7 (SD, 5.4) 23.9 (SD, 4.8) <.005 Lesion volume (mean) (mm3) 1084.8 (SD, 472.5) 1007.3 (SD, 453.4) 1159.1 (SD, 486.1) .110 Lipid-rich necrotic core (mean) (mm3) 143.3 (SD, 76.6) 167.2 (SD, 74.2) 139.8 (SD, 54.5) <.050 Hemorrhage (mean) (mm3 54.5 (SD, 43.1) 58.4 (SD, 46.7) 53.6 (SD, 40.4) .510 Calcification (mean) (mm3) 112.9 (SD, 96.4) 41.3 (SD, 39.5) 141.9 (SD, 107.8) <.001 Dense fibrous tissue (mean) (mm3) 708.2 (SD, 391.1) 689.6 (SD, 372.3) 738.8 (SD, 437.6) .611 Loose matrix (mean) (mm3) 250.3 (SD, 130.5) 219.7 (SD, 103.8) 257.9 (SD, 141.6) .120 Distal occlusion Lumen iso -to hypointensity (No.) (%) 60 (52.6) 45 (59.2) 15 (39.5) .047 Lumen area (mean) (mm2) 6.28 (SD, 3.5) 7.4 (SD, 3.4) 3.9 (SD, 2.3) <.001 Wall area (mean) (mm2) 32.7 (SD, 6.9) 32.0 (SD, 6.8) 33.4 (SD, 8.7) .340 - Table 3:
Factors associated with recanalization success in univariable and multivariable analysis
Characteristic Univariable Analysis Multivariable Analysis OR (95% CI) P OR (95% CI) P Right 0.64 (0.51–1.33) .282 Tapered stump 2.36 (1.02–3.11) .035 2.23 (0.87–3.36) .091 Level of reversed distal ICA flow Communicating segment 0.14 (0.07–0.21) .001 0.13 (0.07–0.24) .010 Ophthalmic segment 0.08 (0.03–0.44) <.001 0.14 (0.08–0.48) .001 Clinoid segment 0.73 (0.63–1.21) .214 0.62 (0.36–1.22) .160 Cavernous segment 1.73 (0.96–3.89) .07 1.66 (0.87–3.54) .550 Petrous segment or below 5.34 (1.41–11.37) <.001 4.07 (1.65–8.38) .001 Collateral circulation Primary 0.55 (0.35–1.59) .143 Secondary 0.36 (0.14–0.71) .027 1.32 (0.98–1.47) .210 Proximal occlusion Lesion length 0.51 (0.13–0.74) .005 0.41 (0.36–0.55) .009 Lesion volume 2.11 (0.71–4.49) .110 Lipid-rich necrotic core 3.26 (1.45–6.36) .024 2.36 (0.94–5.33) .060 Hemorrhage 1.35 (0.65–2.38) .510 Calcification 0.71 (0.44–0.90) <.001 0.56 (0.37–0.68) .002 Dense fibrous tissue 3.31 (0.93–10.36) .615 Loose matrix 1.66 (0.87–3.88) .120 Distal occlusion Lumen iso- to hypointensity 2.23 (1.06–5.29) .047 1.87 (0.91–4.66) .091 Lumen area 1.32 (1.02–2.17) <.001 1.13 (1.04–1.61) .002 Wall area 1.76 (0.71–3.38) .230
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