Early Recurrence in Patients with Symptomatic, Non-Cardioembolic, Internal Carotid Artery Occlusion
Eijirou Tanaka1, Yoshinari Nagakane1, Takehiro Yamada1
1Department of Neurology, Kyoto Second Red Cross Hospital, Kyoto, Japan.
Insights
Early recurrent stroke is common in patients with internal carotid artery occlusion (ICAO). Intracranial occlusion increases stroke risk, with hemodynamic factors being the primary cause of recurrence.
Area of Science:
- Neurology
- Vascular Neurology
- Cerebrovascular Disease
Background:
- Limited data exist on the clinical course of non-cardioembolic internal carotid artery occlusion (ICAO).
- Atherosclerosis is a common cause of ICAO.
Purpose of the Study:
- To determine the frequency of early recurrent ischemic stroke in symptomatic non-cardioembolic ICAO.
- To investigate the underlying pathogenesis of recurrent stroke in these patients.
Main Methods:
- Retrospective review of consecutive patients with symptomatic non-cardioembolic ICAO.
- Exclusion of patients with tandem middle cerebral artery (MCA) occlusion or those who underwent endovascular thrombectomy.
- Classification of patients into cervical or intracranial occlusion groups based on carotid ultrasonography.
- Definition of early recurrent stroke as NIHSS score increase with new MR diffusion-weighted imaging lesions within 30 days.
- Categorization of recurrent stroke pathogenesis as embolic or hemodynamic based on lesion topography.
Main Results:
- Early recurrent stroke occurred in 44.4% of 36 medically treated patients.
- Intracranial occlusion (69.2%) was associated with significantly higher recurrent stroke rates than cervical occlusion (30.4%).
- Hemodynamic pathogenesis (68.8%) was more frequent than embolic (31.2%), particularly in intracranial occlusion (77.8%).
Conclusions:
- Symptomatic non-cardioembolic ICAO carries a high risk of early recurrent stroke.
- Intracranial occlusion is identified as a potential risk factor for early stroke recurrence.
- Hemodynamic factors are the predominant cause of recurrent ischemic stroke in this population.
Introduction:
There 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 Methods:
Consecutive 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.
Results:
Of 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%).
Conclusions:
Early 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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