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Heterogeneity in infarct patterns and clinical outcomes following internal carotid artery occlusion

Thanh G Phan1, Geoffrey A Donnan, Velandai Srikanth

  • 1National Stroke Research Institute and University of Melbourne, Melbourne, Australia. thanh.phan@med.monash.edu.au

Archives of Neurology
|December 17, 2009
PubMed

Insights

Internal carotid artery (ICA) occlusion without middle cerebral artery (MCA) involvement leads to less severe strokes and better outcomes. These patients may benefit from inclusion in acute stroke trials.

Area of Science:

  • Neurology
  • Vascular Neurology
  • Stroke Medicine

Background:

  • Internal carotid artery (ICA) occlusion can lead to stroke, with the extent and severity influenced by collateral circulation and involvement of downstream arteries.
  • The middle cerebral artery (MCA) is a common site for stroke, and its occlusion, either independently or with ICA occlusion, significantly impacts clinical outcomes.

Purpose of the Study:

  • To determine if the extent of infarction and clinical outcomes following internal carotid artery (ICA) occlusion are affected by the additional presence of middle cerebral artery (MCA) occlusion.
  • To compare infarct patterns and clinical outcomes among patients with coexistent ICA and MCA occlusion, isolated ICA occlusion, and isolated MCA occlusion.

Main Methods:

  • A retrospective study comparing infarct patterns and clinical outcomes in stroke patients using statistical parametric mapping.
  • Patients were categorized into three groups: coexistent ICA and MCA occlusion (n=25), isolated ICA occlusion (n=20), and isolated MCA occlusion (n=40).
  • Clinical outcomes were assessed using the modified Rankin scale, with logistic regression used to estimate the independent effect of infarct type on outcomes, adjusting for age and sex.

Main Results:

  • Patients with isolated ICA occlusion exhibited distinct infarct patterns, sparing the insula and superior temporal lobe, resulting in smaller infarct volumes and better modified Rankin scale scores compared to the other groups.
  • Infarct patterns, volume, and rates of poor outcomes were similar between patients with coexistent ICA and MCA occlusion and those with isolated MCA occlusion.
  • The risk of poor clinical outcome was significantly greater in patients with coexistent ICA and MCA occlusion (P=.02) and those with isolated MCA occlusion (P=.06) compared to patients with isolated ICA occlusion, independent of age and sex.

Conclusions:

  • Internal carotid artery (ICA) occlusion without concurrent middle cerebral artery (MCA) occlusion is associated with different infarct patterns, less extensive brain damage, and improved clinical outcomes.
  • Excluding patients with ICA occlusion but without MCA occlusion from acute stroke trials may not be justified, as they represent a distinct clinical entity with potentially better prognoses.
Abstract

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