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Recurrent ischemia in symptomatic carotid occlusion: prognostic value of hemodynamic factors
C J Klijn1, L J Kappelle, A C van Huffelen
1University Department of Neurology, Clinical Neurophysiology and Neurosurgery, the Julius Center for Patient Oriented Research, University Medical Center Utrecht, Utrecht, The Netherlands. c.j.m.klijn@neuro.azu.nl
Insights
Patients with symptomatic carotid artery occlusion (CAO) experiencing cerebral ischemia are at higher risk for recurrent events. Key predictors include hemodynamic symptoms, persistent symptoms post-diagnosis, and leptomeningeal collateral flow.
Area of Science:
- Neurology
- Vascular Neurology
- Cerebrovascular Disease
Background:
- Carotid artery occlusion (CAO) can lead to ischemic stroke.
- Identifying patients at high risk for recurrent events is crucial for timely intervention.
Purpose of the Study:
- To identify hemodynamic factors predicting recurrent ipsilateral cerebral ischemic events in patients with symptomatic CAO.
Main Methods:
- 117 patients with symptomatic CAO and recent ischemic events were studied.
- Cox proportional hazards analysis assessed clinical features, collateral blood flow, and CO2-reactivity.
Main Results:
- Cerebral ischemia symptoms predicted recurrence (HR 3.8).
- Continuing symptoms post-CAO diagnosis increased risk (HR 5.9).
- Leptomeningeal collaterals were associated with higher recurrence risk (HR 4.1). CO2-reactivity did not predict recurrence.
Conclusions:
- Cerebral vs. retinal ischemia, hemodynamic symptoms, persistent symptoms, and leptomeningeal collaterals identify high-risk patients.
- These factors aid in risk stratification for patients with symptomatic CAO.
Objective:
To identify hemodynamic factors that predict recurrence of ipsilateral cerebral ischemic events in patients with symptomatic carotid artery occlusion (CAO).
Patients And Methods:
The authors studied 117 consecutive patients with CAO and corresponding recent (
Results:
None of the 24 patients with symptoms of retinal ischemia alone had a recurrent cerebral ischemic event. In the 93 patients with cerebral ischemic symptoms on entry, recurrence of these symptoms was independently predicted by 1) the nature of the initial symptoms being of purported hemodynamic origin (limb-shaking, precipitation of symptoms by rising, exercise or low blood pressure, retinal claudication) (hazard ratio [HR] 3.8, 95% CI 1.5 to 9.5), 2) continuing symptoms after the CAO had been documented, but before inclusion in the study (HR 5.9, 95% CI 2.2 to 16.1), and 3) the presence of collateral blood flow via leptomeningeal vessels (HR 4.1, 95% CI 1.3 to 13.1). CO(2)-reactivity did not predict recurrence of cerebral ischemic events.
Conclusions:
Having cerebral in contrast to retinal ischemia, clinical features suggestive of hemodynamic compromise, continuing symptoms after demonstration of the CAO, and presence of leptomeningeal collaterals may help to identify patients with symptomatic CAO at high risk of future cerebral ischemia.