Risk prediction of CISS classification in endovascular treatment of basilar artery stenosis

Abstract

Objective: To investigate the incidence of ischemic stroke complications after endovascular treatment for basilar artery stenosis used preoperative high-resolution magnetic resonance vascular wall imaging (HRMR/VWI) and diffusion-weighted imaging (DWI).

Methods: The clinical data of 47 patients with severe symptomatic basilar artery stenosis (stenosis rate ≥70 %) treated with endovascular therapy at the Neuro-interventional Center from December 2017 to December 2021 were retrospectively analyzed. High-resolution magnetic resonance angiography (HRMR VWI) and DWI were used to evaluate the location of atherosclerotic plaque at basilar artery stenosis and the distribution of cerebral infarction lesions in all patients before surgery.According to the CISS classification system for ischemic stroke, patients were divided into a perforation group and a hypoperfusion group, and the general situation, plaque distribution, and incidence of ischemic stroke complications 7 days after endovascular treatment in the two groups were analyzed.

Results: There was no significant difference in baseline data between the two groups. After 7 days of intravascular treatment, the incidence of ischemic stroke was higher in the perforation group (20.0 %) than in the hypoperfusion group (0.0 %), and the difference was statistically significant (P = 0.027). A significant association was found between the perforation group and the hypoperfusion group for the incidence of ischemic stroke at 7 days (P = 0.003, OR = 2.347; 95 % CI = 2.056-4.268). There were a higher proportion of ventral plaques (74.1 %) and a lower proportion of dorsal plaques (33.3 %) in the hypoperfusion group, which were 15.0 % and 90.0 % in the perforation group, respectively (χ2 = 16.045, P < 0.001; χ2 = 15.092, P < 0.001). There was no significant difference in the proportion of left and right plaques between the two groups.

Conclusions: The risk of ischemic stroke is greater in patients with perforator artery obstruction undergoing endovascular therapy, and lower in patients with hypoperfusion/embolus removal.

Keywords: Basilar artery stenosis; Endovascular therapy; High resolution magnetic resonance angiography; Plaque.

Fig. 1

Typical cases for grouping and imaging analysis. 1a. Typical case for perforation group; 1 b. Typical case for the hypoperfusion group. 1c. Typical case for the description of the distribution of basilar artery plaque. There is a greater risk of perforating branch occlusion after dorsal plaque balloon dilation.

Fig. 2

A typical case of acute cerebral infarction is severe stenosis of the middle basilar artery. Male, 64 years old, main reason: “dizziness with right limb weakness for 5 days” admission, history: diabetes, smoking, alcohol history, diagnosis of acute cerebral infarction, severe stenosis of the middle basilar artery. Preoperative physical examination: clear consciousness, fluent speech, limb muscle strength level 5, NIHSS score 0, mRS score 0 points; Preoperative DWI (Fig. A) shows: acute stage of left cerebral infarction of pontine hematosis; The preoperative axial position HRMR—VWI (Fig. B) showed that the basilar artery plaque was eccentric, and the surface was punctate and significantly strengthened, and the plaque mainly affected the dorsal and right sides of the basilar artery wall. Preoperative digital silhouette angiography (Fig. C) showed severe stenosis in the middle of the basilar artery; Endovascular treatment showed significant improvement in stenosis with a balloon dilation at basilar artery stenosis and implantation of one Enterprise2 4.0 × 23 mm stent (Fig. D). 24 h postoperative review DWI showed that the acute stage of bilateral cerebral infarction of the pontine (as shown in Figure E), 7 d postoperative physical examination: clear consciousness, unable to speak, right limb muscle strength level 0, left upper limb muscle strength level 4, left lower limb muscle strength grade 2, NIHSS score 16 points, mRS score 4 points.