Early identification of posterior circulation acute large vessel occlusion induced by intracranial atherosclerotic stenosis
10.3969/j.issn.1008-794X.2025.01.003
- VernacularTitle:后循环颅内动脉粥样硬化性急性大血管闭塞的早期识别
- Author:
Chengshuang YANG
1
;
Sheng LIU
;
Kun LIANG
;
Yuezhou CAO
;
Linbo ZHAO
;
Haibin SHI
;
Zhenyu JIA
Author Information
1. 810007 青海西宁 青海省人民医院急诊科
- Keywords:
acute ischemic stroke;
posterior circulation;
atherosclerosis;
large vessel occlusion;
prediction model
- From:
Journal of Interventional Radiology
2025;34(1):18-23
- CountryChina
- Language:Chinese
-
Abstract:
Objective Based on the clinical data and imaging manifestations of patients with ischemic stroke to establish a simple clinical prediction model that is used for identifying intracranial atherosclerotic stenosis-acute large vessel occlusion(ICAS-LVO in posterior circulation before surgery.Methods The clinical data of patients with acute large vessel occlusion(LVO in the posterior circulation,who received endovascular intervention at the First Affiliated Hospital of Nanjing Medical University of China from January 2019 to September 2022,were retrospectively analyzed.According to the intraoperative angiographic findings,the patients were divided into ICAS-LVO group and non-ICAS-LVO group.Univariate analysis and multivariate logistic regression analysis were used to analyze the patient's demographic characteristics,clinical history,imaging findings,and laboratory results,based on which a clinical prediction model for ICAS-LVO was established,and according to the relevant parameters a nomogram prediction model was plotted.Results A total of 110 patients with LVO in the posterior circulation who received endovascular treatment were included in the final analysis.In 51 patients(49.6％)the cause of vascular occlusion was the atherosclerotic stenosis of the intracranial arteries.Compared with non-ICAS-LVO group,in ICAS-LVO group the patients were younger,the incidence of atrial fibrillation was lower,and the level of plasma D-dimer was lower.Three factors,including atrial fibrillation,occlusion site and collateral circulation status,were finally screened out to establish the prediction model for ICAS-LVO.This model demonstrated acceptable calibration(Hosmer-Lemeshow test,P=0.562)and good discrimination ability(AUC=0.956;95％CI:0.906-0.986).Conclusion The clinical prediction model for ICAS-LVO,which is established on the three predictive factors(absence of atrial fibrillation,occlusion located at the V4 segment of the vertebral artery or at the proximal to mid segment of the basilar artery,and a favorable collateral circulation),carries high sensitivity and accuracy.This model can help neurointervention physicians to make early identification of ICAS-LVO and to promptly formulate vascular recanalization treatment strategies.
