title: Outcome in patients with stroke associated with internal carotid artery occlusion.
abstract: BACKGROUND
  The clinical outcome in patients with stroke associated with internal carotid artery (ICA) occlusion is poor, although a minority may recover without dependency. The purposes of this study were (1) to assess the predictive factors of adverse outcome in patients with stroke associated with an occlusion of the ICA and (2) to evaluate the rate of spontaneous recanalization of an occluded ICA.
  
  
  METHODS
  A total of 177 consecutive patients with first-ever ischemic stroke associated with ICA occlusion were prospectively examined from the Perugia Stroke Registry. Mean age was 71.4 +/- 14.3 years; 53% were males. Multiple regression models were used to analyze predictors of mortality, dependency and ipsilateral stroke recurrence.
  
  
  RESULTS
  The most probable cause of occlusion was atherosclerosis in 65%, cardioembolism in 22%, dissection in 9% and other causes in 4%. Thirty percent of the patients died within 30 days. After a mean follow-up of 420 days (range 1-1,970 days), 45% of the patients had died and 75% had died or were disabled. Another 6% of the patients had a recurrent stroke ipsilateral to the occluded carotid artery. Age was the only predictor of 30-day mortality (77.7 +/- 9.7 vs. 68.7 +/- 15.2 years; p = 0.03) and of long-term mortality or disability (p < 0.003). Hypertension (OR 0.42; 95% CI 0.17-1.00; p = 0.05) was associated with a better outcome within 30 days from stroke onset. Previous ipsilateral transient ischemic attack (OR 0.24; 95% CI 0.06-0.89; p = 0.03) and hyperlipidemia (OR 0.38; 95% CI 0.15-0.99; p = 0.049) were predictors of a better outcome with respect to long-term mortality or disability. No predictors of ipsilateral stroke recurrence were found. One hundred and five out of 177 patients had adequate follow-up ultrasound data. After a mean follow-up of 1.8 years, 10 patients had recanalization of the occluded ICA (2/71 atherosclerosis, 3/19 cardioembolism and 5/15 dissection).
  
  
  CONCLUSIONS
  After a mean follow-up of 1.2 years, 45% of the patients with stroke associated with ICA occlusion had died, while 75% had died or were functionally dependent. The presence of either previous ipsilateral transient ischemic attack, hypertension or hyperlipidemia was associated with a favorable outcome. Recanalization of an occluded ICA occurred in a minority of patients and it was associated with cardioembolism and with arterial dissection.
authors: Stroke Unit, Department of Neuroscience, University of Perugia, Ospedale Silvestrini, Perugia, Italy. mpaciaroni@libero.it
authors: Maurizio
authors: M
authors: Paciaroni
authors: Valeria
authors: V
authors: Caso
authors: Michele
authors: M
authors: Venti
authors: Paolo
authors: P
authors: Milia
authors: L Jaap
authors: LJ
authors: Kappelle
authors: Giorgio
authors: G
authors: Silvestrelli
authors: Francesco
authors: F
authors: Palmerini
authors: Monica
authors: M
authors: Acciarresi
authors: Michela
authors: M
authors: Sebastianelli
authors: Giancarlo
authors: G
authors: Agnelli
mesh_terms: D000368:Aged; D016893:Carotid Stenosis / Q000150:complications* / Q000175:diagnosis; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D020521:Stroke / Q000209:etiology* / Q000401:mortality / Q000628:therapy*; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome