Adrien Ter Schiphorst1, Nicolas Gaillard1, Cyril Dargazanli2, Isabelle Mourand1, Lucas Corti1, Mahmoud Charif1, Xavier Ayrignac1, Anaïs Lippi1, Stéphane Bouly3, Lalu Thibault4, Denis Sablot5, Genevieve Blanchet-Fourcade6, Nicolas Landragin7, Vincent Costalat2, Claire Duflos8, Caroline Arquizan9. 1. Department of Neurology, CHRU Gui de Chauliac, 80 Avenue Augustin Fliche, 34295, Montpellier, France. 2. Department of Neuroradiology, CHRU Gui de Chauliac, Montpellier, France. 3. Department of Neurology, CHRU Carémeau, Nîmes, France. 4. Department of Neurology, CH de Béziers, Béziers, France. 5. Department of Neurology, CH de Perpignan, Perpignan, France. 6. Department of Neurology, CH de Narbonne, Narbonne, France. 7. Department of Neurology, Clinique du Millénaire, Montpellier, France. 8. Clinical Research and Epidemiology Unit, CHU, University Montpellier, Montpellier, France. 9. Department of Neurology, CHRU Gui de Chauliac, 80 Avenue Augustin Fliche, 34295, Montpellier, France. c-arquizan@chu-montpellier.fr.
Abstract
BACKGROUND: Symptomatic isolated carotid artery occlusions (ICAO) can lead to disability, recurrent stroke, and mortality, but natural history and best therapeutic management remain poorly known. The objective of this study was to describe our cohort of ICAO patients with an initial medical management. METHODS: We conducted a retrospective study including consecutive patients admitted to our Comprehensive Stroke Center for ICAO within 24 h after stroke onset between January 2016 and September 2018. Patients with immediate endovascular therapy (EVT) were excluded. Medical treatment was based on anticoagulation (delayed by 24 h if intravenous thrombolysis was performed). 'Rescue' EVT was considered if first-week neurological deterioration (FWND) occurred. RESULTS: Fifty-six patients were included, with a median National Institutes of Health Stroke Scale (NIHSS) of 3. Eleven patients (20%) had FWND during the first week, four benefited from rescue EVT. A mismatch volume > 40 cc on initial perfusion imaging and FLAIR vascular hyperintensities were associated with FWND (p = 0.007 and p = 0.009, respectively). Thirty-eight patients (69%) had a good outcome (modified Rankin Scale mRS 0-2) at 3 months, 36 (69%) had an excellent outcome (mRS 0-1). Seventeen patients (38%) had carotid patency on 3-month control imaging. Recurrences occurred in six (13%) of the survivors (mean follow-up: 13.6 months). CONCLUSION: Our results suggest that the prognosis of patients with acute ICAO was favorable with a medical strategy, albeit a substantial rate of FWND and recurrence. FWND was well predicted by a core-perfusion mismatch volume > 40 cc. Randomized controlled trials are necessary to assess the benefit of EVT in ICAO.
BACKGROUND: Symptomatic isolated carotid artery occlusions (ICAO) can lead to disability, recurrent stroke, and mortality, but natural history and best therapeutic management remain poorly known. The objective of this study was to describe our cohort of ICAO patients with an initial medical management. METHODS: We conducted a retrospective study including consecutive patients admitted to our Comprehensive Stroke Center for ICAO within 24 h after stroke onset between January 2016 and September 2018. Patients with immediate endovascular therapy (EVT) were excluded. Medical treatment was based on anticoagulation (delayed by 24 h if intravenous thrombolysis was performed). 'Rescue' EVT was considered if first-week neurological deterioration (FWND) occurred. RESULTS: Fifty-six patients were included, with a median National Institutes of Health Stroke Scale (NIHSS) of 3. Eleven patients (20%) had FWND during the first week, four benefited from rescue EVT. A mismatch volume > 40 cc on initial perfusion imaging and FLAIR vascular hyperintensities were associated with FWND (p = 0.007 and p = 0.009, respectively). Thirty-eight patients (69%) had a good outcome (modified Rankin Scale mRS 0-2) at 3 months, 36 (69%) had an excellent outcome (mRS 0-1). Seventeen patients (38%) had carotid patency on 3-month control imaging. Recurrences occurred in six (13%) of the survivors (mean follow-up: 13.6 months). CONCLUSION: Our results suggest that the prognosis of patients with acute ICAO was favorable with a medical strategy, albeit a substantial rate of FWND and recurrence. FWND was well predicted by a core-perfusion mismatch volume > 40 cc. Randomized controlled trials are necessary to assess the benefit of EVT in ICAO.
Authors: Maxim Mokin; Tareq Kass-Hout; Omar Kass-Hout; Travis M Dumont; Peter Kan; Kenneth V Snyder; L Nelson Hopkins; Adnan H Siddiqui; Elad I Levy Journal: Stroke Date: 2012-07-17 Impact factor: 7.914
Authors: C J Klijn; P A van Buren; L J Kappelle; C A Tulleken; B C Eikelboom; A Algra; J van Gijn Journal: Eur J Vasc Endovasc Surg Date: 2000-06 Impact factor: 7.069
Authors: Maurizio Paciaroni; Clotilde Balucani; Giancarlo Agnelli; Valeria Caso; Giorgio Silvestrelli; James C Grotta; Andrew M Demchuk; Sung-Il Sohn; Giovanni Orlandi; Didier Leys; Alessandro Pezzini; Andrei V Alexandrov; Mauro Silvestrini; Luisa Fofi; Kristian Barlinn; Domenico Inzitari; Carlo Ferrarese; Rossana Tassi; Georgios Tsivgoulis; Domenico Consoli; Antonio Baldi; Paolo Bovi; Emilio Luda; Giampiero Galletti; Paolo Invernizzi; Maria Luisa DeLodovici; Francesco Corea; Massimo Del Sette; Serena Monaco; Simona Marcheselli; Andrea Alberti; Michele Venti; Monica Acciarresi; Cataldo D'Amore; Federica Macellari; Alessia Lanari; Paolo Previdi; Nicole R Gonzales; Renganayaki K Pandurengan; Farhaan S Vahidy; Melvin Sline; Simerpreet S Bal; Alberto Chiti; Gino Gialdini; Frederic Dumont; Charlotte Cordonnier; Stéphanie Debette; Alessandro Padovani; Raffaella Cerqua; Ulf Bodechtel; Jessica Kepplinger; Mascia Nesi; Patrizia Nencini; Simone Beretta; Claudia Trentini; Giuseppe Martini; Charitomeni Piperidou; Ioannis Heliopoulos; Sebastiano D'Anna; Manuel Cappellari; Edoardo Donati; Giorgio Bono; Elisabetta Traverso; Danilo Toni Journal: Stroke Date: 2011-10-27 Impact factor: 7.914
Authors: Leonard L L Yeo; Wan Yee Kong; Prakash Paliwal; Hock L Teoh; Raymond C Seet; Derek Soon; Rahul Rathakrishnan; Venetia Ong; Tsong-Hai Lee; Ho-Fai Wong; Bernard P L Chan; Wee Kheng Leow; Cheng Yuan; Eric Ting; Anil Gopinathan; Benjamin Y Q Tan; Vijay K Sharma Journal: J Stroke Cerebrovasc Dis Date: 2016-06-22 Impact factor: 2.136
Authors: Matthew L Flaherty; Kelly D Flemming; Robyn McClelland; Neal W Jorgensen; Robert D Brown Journal: Stroke Date: 2004-07-01 Impact factor: 7.914