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Updated: May 23, 2026
Bilateral Common Carotid Artery Occlusion as an Adequate Preconditioning Stimulus to Induce Early Ischemic Tolerance to Focal Cerebral Ischemia
Published on: May 9, 2013
Anterior choroidal artery ischaemic patterns predict outcome of carotid occlusion
Meng Lee1, Jeffrey L Saver, Qing Hao
1UCLA Stroke Center, Los Angeles, CA 90095, USA.
Insights
In acute internal carotid artery (ICA) occlusion, sparing the anterior choroidal artery (AChA) territory or having limited medial temporal lobe (MT) infarction predicts a good outcome. This finding aids in early prognostication for stroke patients.
Area of Science:
- Neurology
- Vascular Neurology
- Neuroimaging
Background:
- Acute internal carotid artery (ICA) occlusion is a critical condition requiring accurate prognostication.
- The anterior choroidal artery (AChA) territory's involvement in stroke may indicate collateral status.
- Identifying predictors of good outcome is crucial for treatment decisions.
Purpose of the Study:
- To determine if AChA territory sparing or medial temporal lobe (MT) restricted infarction predicts a good outcome (modified Rankin Scale 0-2) at discharge.
- To assess the predictive value of AChA infarct patterns in acute ICA occlusion.
Main Methods:
- Retrospective study of 60 patients with acute ICA occlusion.
- MRI and conventional angiography were used for diagnosis and assessment.
- AChA involvement patterns (spared, MT only, partial, full) were analyzed.
- Multivariate logistic regression was employed to assess the association with good discharge outcome.
Main Results:
- AChA territory was spared or restricted to MT in 27 patients; other patterns in 33.
- Sparing or MT-only AChA involvement was independently associated with good discharge outcome (44.4% vs 12.1%).
- Odds ratio for good outcome with spared/MT-only AChA involvement was 7.24 (p=0.023).
Conclusions:
- Absence of AChA infarction or restriction to MT is an independent predictor of good discharge outcome in acute ICA occlusion.
- Analyzing AChA infarct patterns can enhance early prognostication and clinical decision-making.
- This finding supports the utility of neuroimaging in predicting stroke recovery.
Objective:
To investigate whether anterior choroidal artery (AChA) territory sparing or AChA infarction restricted to the medial temporal lobe (MT), implying good collateral status, predicts good outcome, defined as modified Rankin Scale 0-2, at discharge in acute internal carotid artery (ICA) occlusion.
Methods:
The authors studied consecutive patients with acute ICA occlusion admitted to an academic medical centre between January 2002 and August 2010, who underwent MRI followed by conventional angiography. The pattern of AChA involvement on initial diffusion-weighted imaging was dichotomised as spared or MT only versus other partial or full. The association of AChA infarct patterns and good outcome at discharge was calculated by multivariate logistic regression with adjustment.
Results:
For the 60 patients meeting entry criteria, mean age was 68.3 years and median admission NIH Stroke Scale score was 19. AChA territory was spared or restricted to the MT in 27 patients and other partially involved or fully involved in 33 patients. AChA territory spared or ischaemia restricted to MT only, compared with other partial infarct patterns or full infarct, was independently associated with good discharge outcome (44.4% vs 12.1%, OR 7.24, 95% CI 1.32 to 39.89, p=0.023).
Conclusion:
In acute ICA occlusion, the absence of AChA infarction or restriction to the MT is an independent predictor of good discharge outcome. Analysis of AChA infarct patterns may improve early prognostication and decision-making.
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