Research Article: Magnetic resonance imaging and clinical prediction of intracranial atherosclerotic large vessel occlusion in acute ischemic stroke treated with endovascular thrombectomy
Abstract:
Intracranial atherosclerosis-related large-vessel occlusion (ICAS-LVO) poses specific challenges during endovascular thrombectomy, and its early identification is clinically important for efficient recanalization.
This retrospective, singlecenter study included consecutive patients who underwent magnetic resonance imaging (MRI) and endovascular thrombectomy for anterior circulation LVO. The candidate predictor set included predefined MRI markers and clinical variables, including atrial fibrillation, as documented in medical history or electrocardiogram. Variable importance was assessed using a random forest classifier, and the most informative MRI and clinical predictors were then entered into multivariable logistic regression to derive the point-based score. ICAS-LVO discrimination was quantified using the area under the receiver operating characteristic curve (AUC) and internally validated via bootstrap resampling.
Among 335 eligible patients, 44 (13%) had ICAS-LVO. In the multivariable analysis, absence of atrial fibrillation (odds ratio [OR], 20.14; 95% confidence interval [CI], 6.02–89.89; p < 0.001), multiple cortical/border-zone infarcts (OR, 10.96; 95% CI, 3.65–34.90; p < 0.001), mixed acute–subacute lesions (OR, 5.10; 95% CI, 1.51–17.84; p = 0.009), and absence of a susceptibility vessel sign (OR, 4.63; 95% CI, 1.81–12.51; p = 0.002) were independently associated with ICAS–LVO. The resulting ICAS-M score demonstrated high discrimination for ICAS-LVOs in this single-center cohort with 44 ICAS-LVO events (AUC 0.940), which was preserved during internal validation.
In an MRI-capable thrombectomy center, the ICAS-M score demonstrated high, internally validated discrimination for ICAS-LVO and may support the rapid planning of ICAS-tailored endovascular strategies.
Introduction:
Intracranial atherosclerosis-related large-vessel occlusion (ICAS-LVO) poses specific challenges during endovascular thrombectomy, and its early identification is clinically important for efficient recanalization.
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