Predictive performance of the perivascular adipose tissue for endovascular recanalization of chronic carotid artery occlusion.

Objectives: The purpose of this study was to investigate the association between pericarotid fat (PCF) and the success of endovascular recanalization for chronic internal carotid artery occlusion (CICAO), and to establish a scoring system to predict the feasibility of the procedure.

Materials and methods: Sixty-six patients (66 carotid arteries) with CICAO who underwent endovascular recanalization were retrospectively analyzed. Patients' clinical information, the density of PCF, digital subtraction angiography (DSA) characteristics, and procedural results were recorded. Factors related to technical success were analyzed. A nomogram was developed and validated.

Results: Successful recanalization was achieved in 41 (62.1 %) CICAO lesions. Patients in the successful group had a significantly higher PCF density (-42 HU vs. -74 HU; p < 0.001). The cut-off value of PCF density determined by the ROC curve was -61 HU. The multivariable model including conventional variables showed that tapered stump (OR = 4.92; p = 0.017), shorter occlusion length (≤50 mm) (OR = 14.07; p = 0.016), and shorter estimated occlusion duration (OR = 0.87; p = 0.019) were predictors of successful recanalization. The model including only PCF showed that higher PCF density (OR = 1.13; p < 0.001) was associated with successful recanalization. The combined model (including conventional variables and PCF) outperformed the conventional model in discriminating successful recanalization (area under the curve [AUC]: 0.960 vs. 0.854; p = 0.019). The decision curve analysis (DCA) showed that the combined model had good clinical value.

Conclusions: PCF density may serve as a novel imaging biomarker associated with successful endovascular recanalization in symptomatic CICAO. When combined with conventional anatomical features, the proposed nomogram can be used to screen more suitable candidates for recanalization therapy.