title: Residual high-grade stenosis after recanalization of extracranial carotid occlusion in acute ischemic stroke.
abstract: OBJECTIVE
  Residual stenosis after recanalization of an acute symptomatic extracranial occlusion of the internal carotid artery (ICA) might be an indication for carotid endarterectomy. We evaluated the proportion of residual high-grade stenosis (≥70%, near occlusions not included) on follow-up imaging in a consecutive series of patients with an acute symptomatic occlusion of the extracranial ICA.
  
  
  METHODS
  We included patients participating in the Dutch Acute Stroke Study (DUST), who had an acute symptomatic occlusion of the extracranial ICA that was diagnosed on computed tomographic angiography within 9 hours after onset of neurological symptoms. Follow-up imaging of the carotid artery had to be available within 7 days after admission.
  
  
  RESULTS
  Of the 1021 patients participating in DUST between May 2009 and May 2013, an acute symptomatic occlusion of the extracranial ICA was found in 126 (12.3%) patients. Follow-up imaging was available in 86 (68.3%) of these patients. At follow-up, a residual stenosis of <30% was found in 15 (17.4%; 95% confidence interval, 10.8-26.9) patients, a 30% to 49% stenosis in 3 (3.5%; 95% confidence interval, 0.8-10.2) patients, a 50% to 69% stenosis in 2 (2.3%; 95% confidence interval, 0.1-8.6) patients, and a ≥70% stenosis in 14 (16.3%; 95% confidence interval, 9.8-25.6) patients. A near or persistent occlusion was present in the remaining 52 (60.5%) patients.
  
  
  CONCLUSIONS
  A residual high-grade stenosis of the extracranial ICA occurs in 1 of 6 patients with a symptomatic occlusion in the acute stage of cerebral ischemia. Because this may have implications for secondary prevention, we recommend follow-up imaging in these patients within a week after the event.
  
  
  BACKGROUND
  http://www.clinicaltrials.gov. Unique identifier: NCT00880113.
authors.affiliation: From the Department of Neurology, UMC Utrecht Stroke Center, Brain Center Rudolf Magnus (M.J.A.L., M.D., G.J.B., L.J.K.) and Department of Radiology (B.K.V., J.W.D.), University Medical Center Utrecht, Utrecht, The Netherlands. m.luitse-2@umcutrecht.nl.
authors.forename: Merel J A
authors.initials: MJ
authors.lastname: Luitse
authors.affiliation: From the Department of Neurology, UMC Utrecht Stroke Center, Brain Center Rudolf Magnus (M.J.A.L., M.D., G.J.B., L.J.K.) and Department of Radiology (B.K.V., J.W.D.), University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Birgitta K
authors.initials: BK
authors.lastname: Velthuis
authors.affiliation: From the Department of Neurology, UMC Utrecht Stroke Center, Brain Center Rudolf Magnus (M.J.A.L., M.D., G.J.B., L.J.K.) and Department of Radiology (B.K.V., J.W.D.), University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Meenakshi
authors.initials: M
authors.lastname: Dauwan
authors.affiliation: From the Department of Neurology, UMC Utrecht Stroke Center, Brain Center Rudolf Magnus (M.J.A.L., M.D., G.J.B., L.J.K.) and Department of Radiology (B.K.V., J.W.D.), University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Jan Willem
authors.initials: JW
authors.lastname: Dankbaar
authors.affiliation: From the Department of Neurology, UMC Utrecht Stroke Center, Brain Center Rudolf Magnus (M.J.A.L., M.D., G.J.B., L.J.K.) and Department of Radiology (B.K.V., J.W.D.), University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Geert Jan
authors.initials: GJ
authors.lastname: Biessels
authors.affiliation: From the Department of Neurology, UMC Utrecht Stroke Center, Brain Center Rudolf Magnus (M.J.A.L., M.D., G.J.B., L.J.K.) and Department of Radiology (B.K.V., J.W.D.), University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: L Jaap
authors.initials: LJ
authors.lastname: Kappelle
mesh_terms: D000368:Aged; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging*; D016893:Carotid Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D016894:Endarterectomy, Carotid; D057510:Endovascular Procedures / Q000379:methods; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D061185:Mechanical Thrombolysis / Q000379:methods*; D008875:Middle Aged; D011446:Prospective Studies; D012720:Severity of Illness Index; D020521:Stroke / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: angiography, digital subtraction; carotid stenosis; stroke