Factors associated with recurrent stroke and recanalization in patients presenting with isolated symptomatic carotid occlusion

Background and purpose 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...

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Published in:	European journal of neurology Vol. 23; no. 1; pp. 127 - 132
Main Authors:	Damania, D., Kung, N. T.-M., Jain, M., Jain, A. R., Liew, J. A., Mangla, R., Koch, G. E., Sahin, B., Miranpuri, A. S., Holmquist, T. M., Replogle, R. E., Benesch, C. G., Kelly, A. G., Jahromi, B. S.
Format:	Journal Article
Language:	English
Published:	England Blackwell Publishing Ltd 01-01-2016 John Wiley and Sons Inc
Subjects:	Aged Aged, 80 and over Anticoagulants - therapeutic use anticoagulation Arterial Occlusive Diseases - complications Arterial Occlusive Diseases - drug therapy Arterial Occlusive Diseases - therapy Carotid Artery Diseases - complications Carotid Artery Diseases - drug therapy Carotid Artery Diseases - therapy carotid occlusion Endovascular Procedures - statistics & numerical data Female Humans ischaemic stroke Ischemic Attack, Transient - etiology Ischemic Attack, Transient - prevention & control Male Middle Aged Original outcomes prevention Recurrence reperfusion Retrospective Studies Risk Factors Stroke - etiology Stroke - prevention & control treatment Treatment Outcome carotid occlusion treatment ischaemic stroke outcomes anticoagulation reperfusion prevention
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Summary:	Background and purpose 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). Conclusion 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.
Bibliography:	ark:/67375/WNG-QP0D7V0C-Z istex:849AF0AEFB2F09579B18ED229A4281537DC58258 ArticleID:ENE12819 ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1351-5101 1468-1331
DOI:	10.1111/ene.12819