A new angiographic scoring for grading the difficulty of recanalization for symptomatic non-acute middle cerebral artery occlusions

Jie Cao; Xucheng Zhu; Sheng Liu; Yunfeng Zhang; Congguo Yin; Chongke Zhong; Yi Mo; Jinggang Xuan; Ronghua Chen; Chun Zhou; Guoxiang Huang; Wenqing Xia; Wei Xing; Ya Peng

doi:10.3389/fnins.2024.1398749

A new angiographic scoring for grading the difficulty of recanalization for symptomatic non-acute middle cerebral artery occlusions

Front Neurosci. 2024 Oct 8:18:1398749. doi: 10.3389/fnins.2024.1398749. eCollection 2024.

Authors

Jie Cao¹, Xucheng Zhu¹, Sheng Liu², Yunfeng Zhang³, Congguo Yin⁴, Chongke Zhong⁵, Yi Mo¹, Jinggang Xuan¹, Ronghua Chen¹, Chun Zhou², Guoxiang Huang³, Wenqing Xia⁴, Wei Xing⁶, Ya Peng¹

Affiliations

¹ Department of Neurosurgery, The Third Affiliated Hospital of Soochow University, Changzhou, China.
² Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
³ Neurointervention Center, The Affiliated Hospital of Nantong University, Nantong, China.
⁴ Department of Neurology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medical, Hangzhou, China.
⁵ Department of Epidemiology, School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China.
⁶ Department of Radiology, The Third Affiliated Hospital of Soochow University, Changzhou, China.

Abstract

Background: Endovascular recanalization is a feasible option for treating symptomatic non-acute middle cerebral artery occlusion (MCAO) patients. Hence, we aimed to establish a new angiographic scoring to grade the recanalization difficulty of MCAO to determine the suitable patients for endovascular treatment.

Methods: We retrospectively analyzed a total of 113 consecutive recurrent symptomatic non-acute MCAO patients who underwent endovascular recanalization from July 2015 to August 2021 in four Chinese comprehensive stroke centers. All patients were reappraised using a new angiographic scoring based on the stump morphology, the MCA occlusion length, MCA bend, and the distal vascular bed of MCAO. We used the final results to establish the patients' outcomes.

Results: The total successful recanalization and perioperative complication rates were 83.2% (94/113) and 15.9% (18/113), respectively. No deaths occurred within 30 days. Moreover, 96.9, 90, 87.5, 52.6, and 50% of the patients achieved recanalization with scores of 0, 1, 2, 3, and 4 (p < 0.001), respectively. However, the perioperative complication rate showed the opposite trend. (3.1% vs. 7.5% vs. 6.3% vs. 52.6% vs. 50%; p < 0.001). The median time of successful microwire crossing of the occlusion lesion (TMO) in the score 0 group was shorter than the other groups (2 min, 9 min, 8.5 min, 14 min, and 20 min; p < 0.001). When a score of 2 was used as the optimal cut-off point, the sensitivity and specificity were 86.2 and 63.2%, respectively.

Conclusion: The new angiographic scoring can effectively predict the successful recanalization rate, perioperative complication rate, and TMO of endovascular recanalization for non-acute MCAO. It can also be used as an effective clinical evaluation tool to determine the suitable non-acute MCAO patients for recanalization, especially with a score ≤ 2.

Keywords: angiographic scoring; atherosclerosis; balloon dilation; endovascular treatment; recanalization; stent; symptomatic non-acute middle cerebral artery occlusion.

Grants and funding

The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. This work was partly supported by Outstanding Talent of Changzhou "The 14th Five-Year Plan" High-Level Health Talents Training Project (No. 2022260) and Top Talent of Changzhou "The 14th Five-Year Plan" High-Level Health Talents Training Project (No. 2022260).