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ORIGINAL RESEARCH article

Front. Neurosci.
Sec. Brain Imaging Methods
Volume 18 - 2024 | doi: 10.3389/fnins.2024.1398749

A New Angiographic Scoring for Grading the Difficulty of Recanalization for Symptomatic Nonacute Middle Cerebral Artery Occlusions

Provisionally accepted
Jie Cao Jie Cao 1Xucheng Zhu Xucheng Zhu 1Sheng Liu Sheng Liu 2Yunfeng Zhang Yunfeng Zhang 3Congguo Yin Congguo Yin 4Chongke Zhong Chongke Zhong 5Yi Mo Yi Mo 1Jinggang Xuan Jinggang Xuan 1Ronghua Chen Ronghua Chen 1Chun Zhou Chun Zhou 2Huang Guoxiang Huang Guoxiang 3Wenqing Xia Wenqing Xia 4Wei Xing Wei Xing 1*Ya Peng Ya Peng 1*
  • 1 the Third Affiliated Hospital of Soochow University, Changzhou, China
  • 2 The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
  • 3 The Affiliated Hospital of Nantong University, Nantong, China
  • 4 Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medical, Hangzhou, China
  • 5 Suzhou Medical College of Soochow University, Suzhou, China

The final, formatted version of the article will be published soon.

    Background: Endovascular recanalization is a feasible option for treating symptomatic nonacute 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.We retrospectively analyzed a total of 113 consecutive recurrent symptomatic nonacute 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.The new angiographic scoring can effectively predict the successful recanalization rate, perioperative complication rate, and TMO of endovascular recanalization for nonacute MCAO. It can also be used as an effective clinical evaluation tool to determine the suitable nonacute MCAO patients for recanalization, especially with a score ≤ 2.

    Keywords: symptomatic nonacute middle cerebral artery occlusion, endovascular treatment, recanalization, Angiographic scoring, Atherosclerosis, Balloon Dilation, stent

    Received: 10 Mar 2024; Accepted: 12 Aug 2024.

    Copyright: © 2024 Cao, Zhu, Liu, Zhang, Yin, Zhong, Mo, Xuan, Chen, Zhou, Guoxiang, Xia, Xing and Peng. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence:
    Wei Xing, the Third Affiliated Hospital of Soochow University, Changzhou, China
    Ya Peng, the Third Affiliated Hospital of Soochow University, Changzhou, China

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.