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Transient Middle Cerebral Artery Occlusion Model of Stroke
Published on: August 11, 2023
Outcome in patients with stroke associated with internal carotid artery occlusion
Maurizio Paciaroni1, Valeria Caso, Michele Venti
1Stroke Unit, Department of Neuroscience, University of Perugia, Ospedale Silvestrini, Perugia, Italy. mpaciaroni@libero.it
Insights
Stroke patients with internal carotid artery (ICA) occlusion face poor outcomes, with age as a key predictor of mortality. However, hypertension and prior transient ischemic attacks indicate a better prognosis for stroke patients.
Area of Science:
- Neurology
- Vascular Medicine
- Stroke Research
Background:
- Internal carotid artery (ICA) occlusion significantly impacts clinical outcomes in stroke patients, often leading to severe disability or death.
- A minority of patients with ICA occlusion may achieve recovery without significant dependency, highlighting the need to identify predictive factors.
- Understanding the predictors of adverse outcomes and the rate of spontaneous recanalization in ICA occlusion is crucial for improving patient management.
Purpose of the Study:
- To identify predictive factors associated with adverse outcomes in patients experiencing stroke due to internal carotid artery (ICA) occlusion.
- To determine the rate of spontaneous recanalization in occluded internal carotid arteries (ICAs) in a cohort of stroke patients.
- To analyze the relationship between patient demographics, comorbidities, and stroke outcomes, including mortality, dependency, and recurrence.
Main Methods:
- Prospective examination of 177 consecutive patients with first-ever ischemic stroke and ICA occlusion from the Perugia Stroke Registry.
- Utilized multiple regression models to analyze predictors of mortality, dependency, and ipsilateral stroke recurrence.
- Assessed outcomes including 30-day mortality, long-term mortality or disability, and ipsilateral stroke recurrence, with follow-up ultrasound data for recanalization.
Main Results:
- Atherosclerosis (65%) was the most common cause of ICA occlusion, followed by cardioembolism (22%) and dissection (9%).
- Thirty percent of patients died within 30 days; 45% died and 75% were dead or disabled after a mean follow-up of 1.2 years.
- Older age predicted higher mortality and disability; hypertension, previous ipsilateral transient ischemic attack, and hyperlipidemia were associated with better outcomes. Recanalization occurred in a minority (10/105) and was linked to cardioembolism and dissection.
Conclusions:
- Stroke associated with ICA occlusion carries a high mortality and disability rate, with advanced age being a significant negative predictor.
- Favorable outcomes are associated with the presence of prior ipsilateral transient ischemic attack, hypertension, or hyperlipidemia.
- Spontaneous recanalization of the occluded ICA is infrequent and more commonly observed in cases of cardioembolic or dissection-related occlusions.
Background:
The clinical outcome in patients with stroke associated with internal carotid artery (ICA) occlusion is poor, although a minority may recover without dependency. The purposes of this study were (1) to assess the predictive factors of adverse outcome in patients with stroke associated with an occlusion of the ICA and (2) to evaluate the rate of spontaneous recanalization of an occluded ICA.
Methods:
A total of 177 consecutive patients with first-ever ischemic stroke associated with ICA occlusion were prospectively examined from the Perugia Stroke Registry. Mean age was 71.4 +/- 14.3 years; 53% were males. Multiple regression models were used to analyze predictors of mortality, dependency and ipsilateral stroke recurrence.
Results:
The most probable cause of occlusion was atherosclerosis in 65%, cardioembolism in 22%, dissection in 9% and other causes in 4%. Thirty percent of the patients died within 30 days. After a mean follow-up of 420 days (range 1-1,970 days), 45% of the patients had died and 75% had died or were disabled. Another 6% of the patients had a recurrent stroke ipsilateral to the occluded carotid artery. Age was the only predictor of 30-day mortality (77.7 +/- 9.7 vs. 68.7 +/- 15.2 years; p = 0.03) and of long-term mortality or disability (p < 0.003). Hypertension (OR 0.42; 95% CI 0.17-1.00; p = 0.05) was associated with a better outcome within 30 days from stroke onset. Previous ipsilateral transient ischemic attack (OR 0.24; 95% CI 0.06-0.89; p = 0.03) and hyperlipidemia (OR 0.38; 95% CI 0.15-0.99; p = 0.049) were predictors of a better outcome with respect to long-term mortality or disability. No predictors of ipsilateral stroke recurrence were found. One hundred and five out of 177 patients had adequate follow-up ultrasound data. After a mean follow-up of 1.8 years, 10 patients had recanalization of the occluded ICA (2/71 atherosclerosis, 3/19 cardioembolism and 5/15 dissection).
Conclusions:
After a mean follow-up of 1.2 years, 45% of the patients with stroke associated with ICA occlusion had died, while 75% had died or were functionally dependent. The presence of either previous ipsilateral transient ischemic attack, hypertension or hyperlipidemia was associated with a favorable outcome. Recanalization of an occluded ICA occurred in a minority of patients and it was associated with cardioembolism and with arterial dissection.
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