Acute Ischemic Stroke Caused by Internal Carotid Artery Occlusion: Impact of Occlusion Type on the Prognosis.
World Neurosurg
; 164: e387-e396, 2022 08.
Article
in En
| MEDLINE
| ID: mdl-35513277
ABSTRACT
BACKGROUND:
We aimed to compare clinical outcomes of acute ischemic stroke (AIS) due to internal carotid artery (ICA) occlusion following mechanical thrombectomy (MT), focusing on occlusion types.METHODS:
We retrospectively reviewed 67 AIS patients who had an ICA occlusion on computed tomography angiography and underwent MT in a single tertiary center. ICA occlusion types were categorized as (1) true cervical ICA (cICA) occlusion (true occlusion), (2) pseudo-occlusion of the cICA (pseudo-occlusion), and (3) distal ICA (dICA) occlusion. We compared the clinical characteristics and their outcomes according to the ICA occlusion type.RESULTS:
Fourteen patients were diagnosed with true occlusion, 32 with pseudo-occlusion, and 21 with dICA occlusion. The main etiologies were atherothrombotic in true occlusion (64.3%) and cardioembolic in pseudo-occlusion (81.3%) and dICA occlusion (71.4%) (P < 0.001). Pseudo-occlusion showed lower rates of successful reperfusion (37.5%, P = 0.009, 78.6% in true occlusion and 71.4% in dICA occlusion) and poor functional outcome at 3 months (18.8%, P = 0.037, 50% in true occlusion and 47.6% in dICA occlusion) with statistical significance. The infarction volume (169.4 ± 154.4 mL, P = 0.004, 29.2 ± 52.7 mL in true occlusion and 105.8 ± 13.4 mL in dICA occlusion) was significantly higher in pseudo-occlusion. On multivariate logistic analysis, pseudo-occlusion (odds ratio [OR] 4.84, 95% confidence interval [CI] 1.02-22.87, P = 0.023) was an independent risk factor for poor reperfusion, which was significantly associated with a poor functional prognosis (OR 22.04, 95% CI 1.99-243.83, P = 0.012).CONCLUSIONS:
Patients with pseudo-occlusion showed poorer clinical outcomes compared with other ICA occlusion types, possibly due to a poor reperfusion rate after MT.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Carotid Artery Diseases
/
Carotid Stenosis
/
Stroke
/
Ischemic Stroke
Type of study:
Etiology_studies
/
Observational_studies
/
Prognostic_studies
Limits:
Humans
Language:
En
Journal:
World Neurosurg
Journal subject:
NEUROCIRURGIA
Year:
2022
Document type:
Article