Early Recurrence in Patients with Symptomatic,Non-Cardioembolic,Internal Carotid Artery Occlusion |
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| Institution: | 1. Department of Radiology, Mayo Clinic;2. Department of Quantitative Health Sciences, Mayo Clinic;3. Department of Neurology, Mayo Clinic;4. Department of Quantitative Health Sciences, Mayo Clinic;1. Duke University School of Medicine and Fuqua School of Business, DUMC - 3094, Durham, NC 27710, United States;2. Duke University Department of Biostatistics and Bioinformatics, United States;3. Hattiesburg Clinic, United States;4. Duke University Department of Radiology, United States;5. AegisCN LLC, United States;6. Duke University Departments of Anesthesiology and Neurology, Duke Clinical Research Institute and Aegis CN LLC, United States;7. Duke University Departments of Anesthesiology and Neurology and Duke Clinical Research Institute, United States;1. Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N14W5, Kita-Ku, Sapporo 060-8648, Japan;2. Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, N14W5, Kita-Ku, Sapporo 060-8648, Japan;3. Department of Neurosurgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N15W7, Kita-Ku, Sapporo 060-8648, Japan;4. The Division of Clinical Genetics, Hokkaido University Hospital, N14W5, Kita-Ku, Sapporo 060-8638, Japan;5. Department of Molecular Genetics, Wakayama Medical University, Kimiidera 811-1, Wakayama 641-8509, Japan;1. Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand;2. Division of Endocrinology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand;1. University of Iowa Carver College of Medicine, United States;2. University of Iowa, Neurology Residency, United States;3. University of Iowa, Neuroradiology Department, United States;4. University of Iowa, Neurology Department, 200 Hawkins Drive, Iowa City IA 52242, United States;5. Iowa City VA Medical Center, United States |
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| Abstract: | IntroductionThere are limited data on the clinical course of patients with non-cardioembolic, mostly atherosclerotic, internal carotid artery occlusion (ICAO). The purpose of this study was to elucidate the frequency and underlying pathogenesis of early recurrent ischemic stroke in symptomatic non-cardioembolic ICAO.Materials and methodsConsecutive patients with symptomatic non-cardioembolic ICAO were retrospectively reviewed. Those who had a tandem occlusion of the proximal middle cerebral artery (MCA) or underwent endovascular thrombectomy were excluded. Early recurrent stroke was defined as deterioration of the NIHSS score by ≥1 point with new lesions on magnetic resonance (MR) diffusion-weighted imaging (DWI) in the ipsilateral territory of the ICAO within 30 days of the index stroke onset. Patients were classified into two groups on carotid ultrasonography: cervical occlusion and intracranial occlusion. The presumed pathogenesis of recurrent stroke was categorized as embolic or hemodynamic according to the topographical features of subsequent lesions on DWI.ResultsOf 36 consecutive medically treated patients with symptomatic non-cardioembolic ICAO without tandem MCA occlusion, 23 patients had cervical occlusion, and 13 had intracranial occlusion. Early recurrent stroke occurred in 16 patients (44.4%), which happened much more with intracranial occlusion than with cervical occlusion (69.2% vs 30.4%, p<0.02). Focusing on the presumed pathogenesis, hemodynamic was more common than embolic (68.8% vs 31.2%), especially with intracranial occlusion (77.8%).ConclusionsEarly recurrent stroke occurs at a high frequency in symptomatic non-cardioembolic ICAO, and intracranial occlusion may be a risk factor for early recurrent stroke. The pathogenesis of recurrence is more often hemodynamic than embolic. |
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