Factors associated with recurrent stroke and recanalization in patients presenting with isolated symptomatic carotid occlusion.
OBJECTIVE
Patients with symptomatic internal carotid artery (ICA) occlusion constitute a small proportion of stroke/transient ischaemic attack patients who are at increased risk of early stroke recurrence and poor outcome. The optimal medical treatment for patients with symptomatic ICA occlusion who are ineligible for thrombolysis or thrombectomy is unknown.


METHODS
Consecutive patients presenting at a single center with newly diagnosed symptomatic ICA occlusion (not involving the circle of Willis) were retrospectively reviewed. Those treated with intravenous thrombolysis or intra-arterial thrombolysis/thrombectomy were excluded. Patients were divided into two groups based on whether they experienced recurrent in-hospital stroke.


RESULTS
The selected study population (n = 33) represented a small (20.4%) proportion of all newly symptomatic carotid occlusions, who nevertheless had an elevated risk of recurrent stroke during admission (24.2%). Of the variables examined (age, gender, admission National Institutes of Health Stroke Scale score, vascular risk factors, atrial fibrillation, prior stroke/transient ischaemic attack and anticoagulation within 48 h of presentation), only anticoagulation was significantly associated with a lower risk of in-hospital recurrent stroke. Anticoagulated patients showed a decreased incidence of stroke recurrence within the first week (6.7% vs. 38.9%, P = 0.032) and fewer strokes or deaths at 1 month (13.3% vs. 47.1%, P = 0.040). Hemorrhagic transformation was not observed in any patient. On follow-up imaging, ICA recanalization was significantly more frequent in anticoagulated patients (46.2% vs. 9.1%, P = 0.047).


CONCLUSIONS
Patients with newly diagnosed symptomatic ICA occlusion (not involving the circle of Willis) represent a small but high risk subgroup of patients with carotid occlusion. Early anticoagulation was associated with fewer recurrent strokes and increased ICA recanalization. Larger scale prospective studies may be justified.
Department of Neurosurgery, University of Rochester Medical Center, Rochester, NY, USA.
D
D
Damania
Department of Neurosurgery, University of Rochester Medical Center, Rochester, NY, USA.
N T-M
NT
Kung
Department of Neurosurgery, University of Rochester Medical Center, Rochester, NY, USA.
M
M
Jain
Department of Neurosurgery, University of Rochester Medical Center, Rochester, NY, USA.
A R
AR
Jain
Department of Neurosurgery, University of Rochester Medical Center, Rochester, NY, USA.
J A
JA
Liew
Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA.
R
R
Mangla
Department of Neurosurgery, University of Rochester Medical Center, Rochester, NY, USA.
G E
GE
Koch
Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA.
B
B
Sahin
Department of Neurosurgery, University of Rochester Medical Center, Rochester, NY, USA.
A S
AS
Miranpuri
Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA.
T M
TM
Holmquist
Department of Neurosurgery, University of Rochester Medical Center, Rochester, NY, USA.
R E
RE
Replogle
Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA.
C G
CG
Benesch
Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA.
A G
AG
Kelly
Department of Neurosurgery, University of Rochester Medical Center, Rochester, NY, USA.
B S
BS
Jahromi
D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D001157:Arterial Occlusive Diseases / Q000150:complications / Q000188:drug therapy / Q000628:therapy*; D002340:Carotid Artery Diseases / Q000150:complications / Q000188:drug therapy / Q000628:therapy*; D057510:Endovascular Procedures / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome
D000925:Anticoagulants
anticoagulation; carotid occlusion; ischaemic stroke; outcomes; prevention; reperfusion; treatment