Outcome of acute stroke patients without visible occlusion on early arteriography.
BACKGROUND
The aim of this study was to determine the clinical and radiological outcome of acute stroke patients who had no vessel occlusion on arteriography and to define predictors of clinical outcome.


METHODS
We analyzed clinical and radiological data of stroke patients whose arteriography performed within 6 hours of symptom onset did not visualize any vessel occlusion.


RESULTS
Twenty-eight of 283 consecutive patients (10%) who underwent arteriography with the intention to perform intraarterial thrombolysis did not show any arterial occlusion. Their median baseline National Institutes of Health Stroke Scale (NIHSS) score was 7. Time from symptom onset to arteriography ranged from 115 to 315 minutes; on average, it was 226 minutes. Presumed stroke cause was cardiac embolism in 11 patients (39%), small artery disease in 6 (21%), coronary angiography in 1 (4%), and undetermined in 10 patients (36%). After 3 months, modified Rankin Scale score (mRS) was < or =2 in 21 patients (75%), indicating a favorable outcome. Six patients (21%) had a poor outcome (mRS 3 or 4) and 1 patient (4%) had a myocardial infarction and died. Twenty-seven patients had follow-up brain imaging. It was normal in 5, showed a lacunar lesion in 8, a striatocapsular infarct in 2, a small or medium-sized anterior circulation infarct in 6, multiple small anterior circulation infarcts in 2, and multiple posterior circulation infarcts in 4. No predictors of clinical outcome were identified.


CONCLUSIONS
Most acute stroke patients with normal early arteriography show infarcts on brain imaging; however, clinical outcome is usually favorable.
Arnold
Marcel
M
Department of Neurology, University of Berne, Berne, Switzerland.
Nedeltchev
Krassen
K
Brekenfeld
Caspar
C
Fischer
Urs
U
Remonda
Luca
L
Schroth
Gerhard
G
Mattle
Heinrich
H
D000293:Adolescent; D000328:Adult; D000368:Aged; D000792:Angiography; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging*; D001921:Brain / Q000098:blood supply*; D020520:Brain Infarction / Q000175:diagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis* / Q000000981:diagnostic imaging*