Work

Prediction of Occlusion Duration in Nonacute Intracranial Large Artery Through High‐Resolution Vessel Wall Imaging

Year: 2025

Type: article

Abstract: Background Accurately assessing the duration of nonacute intracranial large vessel occlusion (ILVO) is critical, because occlusion exceeding 3 months significantly reduces endovascular treatment efficacy. This study explores high‐resolution vessel wall imaging to differentiate subacute (3 days–1 month), short‐duration chronic (1–3 months), and long‐duration chronic (>3 months) ILVOs. Methods A retrospective analysis was conducted on consecutive patients with nonacute ILVOs with well‐documented clinical courses (June 2018–March 2022). High‐resolution vessel wall imaging pre‐ and postcontrast features, including traditional and histogram characteristics, were evaluated. Logistic regression identified key determinants for distinguishing occlusion durations. Endovascular treatment outcomes were assessed in a subset of patients. Results Among 218 ILVOs (77 subacute, 69 short‐duration chronic, 72 long‐duration chronic), multivariate analysis identified signal intensity (odds ratio [OR], 3.71; P <0.001), enhancement index (OR, 1.79; P< 0.001), precontrast skewness (OR, 4.41; P =0.04), and postcontrast coefficient of variation (OR, 9.34; P< 0.001) as significant for differentiating subacute and long‐duration chronic ILVOs. Short‐ versus long‐duration chronic ILVOs were distinguished by signal intensity (OR, 4.02; P< 0.001), enhancement index (OR, 2.02; P< 0.001), lumen diameter (OR, 1.70; P= 0.002), and precontrast skewness (OR, 4.91; P= 0.047). Short‐duration ILVOs showed higher recanalization success (91.7% versus 61.9%, P= 0.02) and required fewer stents (45.8% versus 90.5%, P= 0.02) compared with long‐duration ILVOs. Conclusions High‐resolution vessel wall imaging features effectively differentiate ILVO durations, providing structural insights into occluded vessels. These findings can guide endovascular recanalization strategies, emphasizing the importance of occlusion duration in treatment planning.

Source: Journal of the American Heart Association

DOI: 10.1161/jaha.125.041861