{
  "abstract": "Background and objectives Acute occlusion of the internal carotid artery (ICA) accompanied by contralateral A1 segment agenesis (CA-A1) presents distinct clinical and radiological features. Differentiating CA-A1 from non-CA-A1 cases in acute ICA occlusion based on preoperative angiography images is challenging. We hypothesized that CT perfusion (CTP) could help to quickly and accurately recognize acute ICA occlusions with CA-A1 and that the double stent retriever (DSR) technique might improve radiological outcomes in ICA occlusion with CA-A1.Methods ICA occlusion cases were categorized into CA-A1 and non-CA-A1 groups. The diagnostic performance of CTP for CA-A1 was assessed, and radiological outcomes were compared between DSR and non-DSR groups in the CA-A1 group.Results A total of 281 cases of acute ICA occlusion were included: 34 with CA-A1 and 247 without CA-A1. Bilateral anterior cerebral artery (ACA) perfusion abnormalities on CTP were more frequent in the CA-A1 group (97.1% vs 5.3%, P<0.001). CTP showed 97% sensitivity, 95% specificity, and 95% accuracy for diagnosing CA-A1. Distal embolism into the ipsilateral ACA was more frequent in the CA-A1 group (29.4% vs 6.5%, P<0.001). Seven ICA occlusions with CA-A1 underwent the DSR technique as the first-line strategy. The risk of distal embolism into the ipsilateral ACA was significantly reduced compared with that in non-DSR cases (0% vs 40.7%, P=0.046).Conclusion CTP can accurately and quickly detect CA-A1 in acute ICA occlusion. Distal embolism into the ipsilateral ACA is common in the CA-A1 group, and the DSR technique significantly reduces its incidence, showing promise as a first-line strategy.",
  "authors": [
    {
      "affiliations": [
        "Neurology, Zhangzhou Municipal Hospital of Fujian Province and Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian, China"
      ],
      "name": "Tingyu Yi"
    },
    {
      "affiliations": [
        "Neurology, Zhangzhou Municipal Hospital of Fujian Province and Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian, China"
      ],
      "name": "Zhi-nan Pan"
    },
    {
      "affiliations": [
        "Neurology, Zhangzhou Municipal Hospital of Fujian Province and Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian, China"
      ],
      "name": "Ding-lai Lin"
    },
    {
      "affiliations": [
        "Neurology, Fujian Medical University Union Hospital, Fuzhou, Fujian, China"
      ],
      "name": "Shujuan Gan"
    },
    {
      "affiliations": [
        "Neurology, Fujian Medical University Union Hospital, Fuzhou, Fujian, China"
      ],
      "name": "Jintao Chen"
    },
    {
      "affiliations": [
        "Neurology, Zhangzhou Municipal Hospital of Fujian Province and Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian, China"
      ],
      "name": "Yuehong He"
    },
    {
      "affiliations": [
        "Neurology, Zhangzhou Municipal Hospital of Fujian Province and Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian, China"
      ],
      "name": "Yan-min Wu"
    },
    {
      "affiliations": [
        "Neurology, Zhangzhou Municipal Hospital of Fujian Province and Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian, China"
      ],
      "name": "Xiao-hui Lin"
    },
    {
      "affiliations": [
        "Neurology, Zhangzhou Municipal Hospital of Fujian Province and Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian, China"
      ],
      "name": "Lisan Zeng"
    },
    {
      "affiliations": [
        "Neurology, Zhangzhou Municipal Hospital of Fujian Province and Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian, China"
      ],
      "name": "Mei-hua Wu"
    },
    {
      "affiliations": [
        "School Of Clinical Medicine, Fujian Medical University, Zhangzhou, Fujian, China"
      ],
      "name": "Weifeng Huang"
    },
    {
      "affiliations": [
        "Neurology, Zhangzhou Municipal Hospital of Fujian Province and Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian, China"
      ],
      "name": "Shuyi Liu"
    },
    {
      "affiliations": [
        "Neurology, Zhangzhou Municipal Hospital of Fujian Province and Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian, China"
      ],
      "name": "Yi-ning Yang"
    },
    {
      "affiliations": [
        "Neurology, Zhangzhou Municipal Hospital of Fujian Province and Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian, China"
      ],
      "name": "Jinhua Ye"
    },
    {
      "affiliations": [
        "Neurology, Fujian Medical University Union Hospital, Fuzhou, Fujian, China"
      ],
      "name": "Wen-huo Chen"
    }
  ],
  "title": "Diagnostic performance of CT perfusion in detecting contralateral aplasia of the A1 segment in acute internal carotid artery occlusion",
  "uid": "ecc45053-1e61-58b0-996a-7ccae7085508"
}