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Prognostic factors in first-ever stroke in the carotid artery territory seen within 6 hours after onset
B Censori1, M Camerlingo, L Casto
1Second Division of Neurology, Ospedali Riuniti, Bergamo, Italy.
Insights
Early stroke severity and atrial fibrillation predict poor outcomes after carotid artery stroke. These factors help stratify patients for clinical trials and guide treatment decisions for better functional recovery.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Medical Imaging
Background:
- Stroke in the carotid artery territory poses significant risks for functional outcome.
- Early detection of prognostic factors is crucial for timely intervention and patient management.
Purpose of the Study:
- To identify prognostic factors for functional outcome within the first 6 hours after a first-ever carotid artery stroke.
- To aid in patient stratification for clinical trials and improve prognostic accuracy.
Main Methods:
- A cohort of 172 patients with carotid artery stroke was analyzed.
- Variables included demographics, stroke severity (Canadian Neurological Scale), comorbidities, cardioembolic sources, and CT lesion characteristics.
- Outcome was assessed using the modified Rankin scale at 30 days and 6 months.
Main Results:
- Older age (≥70 years), severe neurological deficit (Canadian Scale < 6.5), atrial fibrillation, cardioembolic source, and large CT lesions were associated with worse outcomes.
- Multivariate analysis identified severe deficit (Canadian Scale < 6.5) and atrial fibrillation as significant predictors of early handicap or death.
Conclusions:
- Neurological deficit severity is the most critical prognostic indicator in acute carotid ischemic stroke.
- Atrial fibrillation is a significant factor for early handicap but not overall mortality.
- These prognostic indicators can guide patient stratification in clinical trials.
Background And Purpose:
We sought to detect prognostic factors related to functional outcome during the first 6 hours after a first-ever stroke in the carotid artery territory.
Methods:
All patients with these characteristics seen during a 3-year period were included. Outcome was evaluated according to a modified Rankin scale. The following variables were examined at univariate analysis: sex, age, severity of deficit at entry and at day 7, level of consciousness at entry, time after symptom onset, history of smoking, history of hypertension, diabetes, myocardial infarction, atrial fibrillation, rheumatic heart disease, dilated cardiomyopathy, all potential cardioembolic sources, presence of a consistent lesion on computed tomography at entry and at days 5-9, and the size of such lesion.
Results:
All entry criteria were met by 172 patients. Age > or = 70 years, a Canadian Neurological Scale score < 6.5 at entry and at day 7, atrial fibrillation, presence of a potential cardioembolic source, and a "large" lesion (involving more than half the cerebral lobe) on computed tomography at days 5-9 were associated with a significantly worse outcome both at 30 days and at 6 months. After multivariate analysis, a Canadian Scale score < 6.5 at entry (p < 0.0001) and atrial fibrillation (p = 0.005) were associated with a significant handicap or death at 30 days, whereas only a Canadian Scale score < 6.5 (p < 0.0001) was associated with a worse prognosis at 6 months. An association of age > or = 70 years with a worse outcome at 6 months was of borderline significance (p = 0.054).
Conclusions:
Some prognostic indicators are available during the first few hours after onset of a carotid ischemic stroke and may be useful in the stratification of patients in clinical trials. Severity of deficit is the most important indicator, whereas the presence of atrial fibrillation worsens the prognostic outlook with respect to early handicap but not mortality.