Intracranial Carotid Artery Calcification Relates to Recanalization and Clinical Outcome After Mechanical Thrombectomy

Abstract

Background and Purpose— Intracranial carotid artery calcification (ICAC) is a surrogate marker of intracranial arteriosclerosis, which may impact the revascularization and clinical outcome of acute stroke patients who undergo mechanical thrombectomy. Methods— We included 194 patients admitted to our Stroke Unit between January 2009 and September 2015 who underwent mechanical thrombectomy for an anterior circulation occlusion. ICAC was quantified in both intracranial carotid arteries on the nonenhanced computed tomographic scan that was acquired before thrombectomy. Complete arterial revascularization was defined as a Thrombolysis in Cerebral Infarction ≥2b on the final angiographic examination. Poor functional outcome was defined as a modified Rankin Scale score of >2 at 90 days. We assessed the independent effect of ICAC volume on complete arterial revascularization, functional outcome, and mortality using logistic regression models adjusted for relevant confounders. Results— ICAC was present in 164 (84.5%) patients, with a median volume of 87.1 mm 3 (25th–75th quartile: 18.9–254.6 mm 3 ). We found that larger ICAC volumes were associated with incomplete arterial revascularization (adjusted odds ratio per unit increase in ln-transformed ICAC volume 0.73 [95% confidence interval, 0.57–0.93]) and with poorer functional outcome (adjusted odds ratio per unit increase in ln-transformed ICAC volume 1.31 [95% confidence interval, 1.04–1.66]). Conclusions— A larger amount of ICAC before mechanical thrombectomy in acute stroke patients is an indicator of worse postprocedural arterial revascularization and poorer functional outcome.

Intracranial Carotid Artery Calcification and Effect of Endovascular Stroke Treatment

“…In our analysis, the volume of ICAC was not associated with functional outcome as opposed to a recent observational study. 2 This discrepancy may be explained by different study design, but selection of patients may have contributed to the findings. In that study, EVT was not yet standard care.…”

“…In particular, a larger amount of highly prevalent intracranial carotid artery calcification (ICAC) may be an indicator of poor functional outcome in AIS patient treated by EVT. 2,3 One study reported an association between ICAC volume and poor recanalization status, which could not be explained by differences in procedural difficulties like accessibility of target occlusion, number of passes or periprocedural complications. 2…”

Lack of Correlation Between Intracranial Carotid Artery Modified Woodcock Calcification Score and Prognosis of Patients With Acute Ischemic Stroke After Intravenous Thrombolysis

“…Lee et al (30) reported that a high ICAC burden was associated with grave prognosis (mRS ≥ 5) after revascularization in patients with acute middle cerebral artery trunk occlusion. Hernandez-Perez et al (31) showed that the presence of severe ICAC was associated with poorer functional outcomes after endovascular thrombectomy in patients with anterior circulation large artery occlusion. In contrast, another study concluded that extensive ICAC did not have an impact on reperfusion or clinical outcomes in AIS patients undergoing endovascular therapy (14).…”

Intracranial Calcification is Predictive for Hemorrhagic Transformation and Prognosis After Intravenous Thrombolysis in Non-Cardioembolic Stroke Patients

“…We used the ITK-SNAP Medical Image Segmentation Tool, which is third-party image semi-quantitative segmentation measurement software developed by the National Institutes of Health and the National Center for Biomedical Imaging and Bioengineering 19,20) . Intracranial calcification was defined as a CT value 130 HU within the vessel regions 21,22) . The calcification region was segmented by ITK-SNAP and then delineated manually on each successive layer to obtain the exact number of pixels and the volume of the region of interest, thereby obtaining each blood vessel's calcification volume (typical case shown in Fig.…”