Does acute occlusion of the carotid T invariably have a poor outcome?
OBJECTIVE
To evaluate the prognosis of patients with acute occlusion of the carotid T.


METHODS
The authors studied 42 consecutive patients with acute carotid T occlusion, age 66 (59 to 74) years (median [interquartile range]). T occlusion was diagnosed with transcranial Doppler sonography (TCD; n = 11) and MR (n = 28) or CT (n = 3) angiography. Final infarction size was evaluated on follow-up CT 3 to 7 days after symptom onset and recanalization by follow-up TCD 24 to 36 hours after symptom onset.


RESULTS
NIH Stroke Scale (NIHSS) score on admission was 18 (16 to 20). Final infarct size was one-third or less of the middle cerebral artery (MCA) territory in 11, greater than one-third but less than or equal to two-thirds of the MCA territory in 10, and greater than two-thirds of the MCA territory in 21 patients. Modified Rankin Scale (mRS) score 6 months after stroke onset was 2 in 7 (17%), 3 in 2 (5%), 4 in 13 (31%), 5 in 7 (17%), and 6 in 13 (31%) patients. Complete or partial MCA recanalization within 24 hours after symptom onset was observed in 12 of 18 patients treated with thrombolysis and 4 of the remaining 24 patients (p = 0.001) and was associated with better clinical outcome (mRS 2, recanalization 6/7 [86%]; mRS 3 to 5, recanalization 8/22 [36%]; mRS 6, recanalization 2/13 [15%]; p = 0.01). Recanalization and NIHSS score on admission were independent predictors of outcome.


CONCLUSIONS
Acute carotid T occlusion does not necessarily carry a poor prognosis. IV thrombolysis frequently results in recanalization, which is related to a better clinical outcome and smaller final infarction size.
Georgiadis
D
D
Department of Neurology, University of Heidelberg, Germany. Dimitrios.Georgiadis@usz.ch
Oehler
J
J
Schwarz
S
S
Rousson
V
V
Hartmann
M
M
Schwab
S
S
D000208:Acute Disease; D000368:Aged; D001161:Arteriosclerosis / Q000150:complications; D001925:Brain Damage, Chronic / Q000453:epidemiology / Q000209:etiology; D001929:Brain Edema / Q000209:etiology / Q000628:therapy; D002343:Carotid Artery, Internal / Q000473:pathology*; D016893:Carotid Stenosis / Q000150:complications / Q000188:drug therapy / Q000473:pathology*; D015331:Cohort Studies; D003131:Combined Modality Therapy; D003399:Craniotomy / Q000379:methods; D004677:Encephalocele / Q000209:etiology; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D007036:Hypothermia, Induced; D020244:Infarction, Middle Cerebral Artery / Q000188:drug therapy / Q000209:etiology* / Q000401:mortality / Q000473:pathology / Q000628:therapy; D007262:Infusions, Intravenous; D020766:Intracranial Embolism / Q000209:etiology; D019586:Intracranial Hypertension / Q000209:etiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index; D013557:Switzerland / Q000453:epidemiology; D015912:Thrombolytic Therapy; D016896:Treatment Outcome
D005343:Fibrinolytic Agents