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Death from ischemic stroke in the anterior circulation: the contralateral carotid matters
M V Baptista1, G van Melle, J Bogousslavsky
1Service de Neurologie, Centre Hospitalier Universitaire Vaudois, Université de Lausanne, Suisse, Switzerland.
Insights
Internal carotid artery (ICA) stenosis impacts stroke outcomes. Higher ipsilateral ICA stenosis correlates with increased stroke death, while contralateral stenosis may worsen outcomes in those without ipsilateral blockage.
Area of Science:
- Neurology
- Vascular Medicine
- Stroke Research
Background:
- Acute hemispheric infarction mortality is linked to stroke size.
- The role of internal carotid artery (ICA) stenosis in stroke size and mortality is not well understood.
Purpose of the Study:
- To investigate the relationship between ipsilateral and contralateral ICA stenosis, infarct type, and mortality in patients with anterior circulation infarction.
Main Methods:
- Analysis of 2,148 first-ever stroke patients from the Lausanne Stroke Registry with anterior circulation infarction.
- Assessment of ipsilateral and contralateral ICA stenosis using Doppler ultrasonography and Duplex-scanning during the acute stroke phase.
- Comparison of case fatality ratios (CFR) across different degrees of ICA stenosis, considering various clinical factors.
Main Results:
- Mortality significantly increased with higher degrees of ipsilateral ICA stenosis (p = 0.026).
- Contralateral ICA stenosis did not significantly affect mortality on its own.
- Patients without ipsilateral ICA stenosis had significantly higher mortality if contralateral stenosis was present (16.7% vs 2.7%, p = 0.013).
- This subgroup also showed increased stroke involving the middle cerebral artery territory and impaired consciousness.
Conclusions:
- Ipsilateral ICA stenosis is a significant predictor of increased stroke mortality.
- Contralateral ICA patency may be crucial in mitigating stroke severity and mortality in patients with no ipsilateral stenosis.
Abstract:
Death from acute hemispheric infarction is commonly associated with stroke size, but the potential role of the internal carotid artery (ICA) in this phenomenon is poorly understood. The aim of the present study was to analyse the relation between the degree of ipsilateral and contralateral ICA stenosis, infarct type and death. We studied 2,148 first-ever stroke patients with anterior circulation infarction from the Lausanne Stroke Registry. Doppler ultrasonography with frequency spectral analysis and Duplex-scanning were performed systematically during the acute phase of stroke. The patients were divided into groups according to the degree of ipsilateral and contralateral ICA stenosis. The case fatality ratios (CFR) at hospital discharge were obtained for each group. Several clinical features including age, stroke topography, level of consciousness, limb weakness on admission, type of onset, hyperglycemia, previous transient ischemic attack, cardiac ischemia, cardiac arrhythmia and left ventricular hypertrophy were also studied. Mortality increased significantly with ipsilateral ICA stenosis: 50% and 90% stenosis, 5.6%, (24/429); p = 0.026, but not significantly with contralateral ICA stenosis. However, patients without ipsilateral ICA stenosis had significantly higher mortality when contralateral stenosis was present: 16.7% (3/18) versus 2.7% (41/1,531), p = 0.013. This corresponded to an increased frequency of strokes involving the whole middle cerebral artery territory, with impaired consciousness at onset of stroke. Patients with ipsilateral stenosis had similar CFR independently of the presence or absence of contralateral stenosis. In conclusion, patency of the contralateral ICA may be an important contributory factor of larger infarction and indirectly of stroke mortality in patients with no ipsilateral stenosis.