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Factors associated with recurrent stroke and recanalization in patients presenting with isolated symptomatic carotid occlusion.

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Title: Factors associated with recurrent stroke and recanalization in patients presenting with isolated symptomatic carotid occlusion.
Authors: Damania, D., Kung, N. T. ‐ M., Jain, M., Jain, A. R., Liew, J. A., Mangla, R., Koch, G. E., Sahin, B., Miranpuri, A. S., Holmquist, T. M., Replogle, R. E., Benesch, C. G., Kelly, A. G., Jahromi, B. S.
Source: European Journal of Neurology. Jan2016, Vol. 23 Issue 1, p127-132. 6p.
Subjects: Stroke, Internal carotid artery, Arterial occlusions, Thrombolytic therapy, Reperfusion injury, Anticoagulants
Abstract: Background and purpose: Patients with symptomatic internal carotid artery (ICA) occlusion constitute a small proportion of stroke/transient ischaemic attack patients who are at increased risk of early stroke recurrence and poor outcome. The optimal medical treatment for patients with symptomatic ICA occlusion who are ineligible for thrombolysis or thrombectomy is unknown. Methods: Consecutive patients presenting at a single center with newly diagnosed symptomatic ICA occlusion (not involving the circle of Willis) were retrospectively reviewed. Those treated with intravenous thrombolysis or intraarterial thrombolysis/thrombectomy were excluded. Patients were divided into two groups based on whether they experienced recurrent in-hospital stroke. Results: The selected study population (n = 33) represented a small (20.4%) proportion of all newly symptomatic carotid occlusions, who nevertheless had an elevated risk of recurrent stroke during admission (24.2%). Of the variables examined (age, gender, admission National Institutes of Health Stroke Scale score, vascular risk factors, atrial fibrillation, prior stroke/transient ischaemic attack and anticoagulation within 48 h of presentation), only anticoagulation was significantly associated with a lower risk of in-hospital recurrent stroke. Anticoagulated patients showed a decreased incidence of stroke recurrence within the first week (6.7% vs. 38.9%, P = 0.032) and fewer strokes or deaths at 1 month (13.3% vs. 47.1%, P = 0.040). Hemorrhagic transformation was not observed in any patient. On follow-up imaging, ICA recanalization was significantly more frequent in anticoagulated patients (46.2% vs. 9.1%, P = 0.047). Conclusion: Patients with newly diagnosed symptomatic ICA occlusion (not involving the circle of Willis) represent a small but high risk subgroup of patients with carotid occlusion. Early anticoagulation was associated with fewer recurrent strokes and increased ICA recanalization. Larger scale prospective studies may be justified. [ABSTRACT FROM AUTHOR]
Copyright of European Journal of Neurology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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  Data: Factors associated with recurrent stroke and recanalization in patients presenting with isolated symptomatic carotid occlusion.
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  Data: <searchLink fieldCode="AR" term="%22Damania%2C+D%2E%22">Damania, D.</searchLink><br /><searchLink fieldCode="AR" term="%22Kung%2C+N%2E+T%2E+‐+M%2E%22">Kung, N. T. ‐ M.</searchLink><br /><searchLink fieldCode="AR" term="%22Jain%2C+M%2E%22">Jain, M.</searchLink><br /><searchLink fieldCode="AR" term="%22Jain%2C+A%2E+R%2E%22">Jain, A. R.</searchLink><br /><searchLink fieldCode="AR" term="%22Liew%2C+J%2E+A%2E%22">Liew, J. A.</searchLink><br /><searchLink fieldCode="AR" term="%22Mangla%2C+R%2E%22">Mangla, R.</searchLink><br /><searchLink fieldCode="AR" term="%22Koch%2C+G%2E+E%2E%22">Koch, G. E.</searchLink><br /><searchLink fieldCode="AR" term="%22Sahin%2C+B%2E%22">Sahin, B.</searchLink><br /><searchLink fieldCode="AR" term="%22Miranpuri%2C+A%2E+S%2E%22">Miranpuri, A. S.</searchLink><br /><searchLink fieldCode="AR" term="%22Holmquist%2C+T%2E+M%2E%22">Holmquist, T. M.</searchLink><br /><searchLink fieldCode="AR" term="%22Replogle%2C+R%2E+E%2E%22">Replogle, R. E.</searchLink><br /><searchLink fieldCode="AR" term="%22Benesch%2C+C%2E+G%2E%22">Benesch, C. G.</searchLink><br /><searchLink fieldCode="AR" term="%22Kelly%2C+A%2E+G%2E%22">Kelly, A. G.</searchLink><br /><searchLink fieldCode="AR" term="%22Jahromi%2C+B%2E+S%2E%22">Jahromi, B. S.</searchLink>
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  Data: <searchLink fieldCode="JN" term="%22European+Journal+of+Neurology%22">European Journal of Neurology</searchLink>. Jan2016, Vol. 23 Issue 1, p127-132. 6p.
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  Data: <searchLink fieldCode="DE" term="%22Stroke%22">Stroke</searchLink><br /><searchLink fieldCode="DE" term="%22Internal+carotid+artery%22">Internal carotid artery</searchLink><br /><searchLink fieldCode="DE" term="%22Arterial+occlusions%22">Arterial occlusions</searchLink><br /><searchLink fieldCode="DE" term="%22Thrombolytic+therapy%22">Thrombolytic therapy</searchLink><br /><searchLink fieldCode="DE" term="%22Reperfusion+injury%22">Reperfusion injury</searchLink><br /><searchLink fieldCode="DE" term="%22Anticoagulants%22">Anticoagulants</searchLink>
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Background and purpose: Patients with symptomatic internal carotid artery (ICA) occlusion constitute a small proportion of stroke/transient ischaemic attack patients who are at increased risk of early stroke recurrence and poor outcome. The optimal medical treatment for patients with symptomatic ICA occlusion who are ineligible for thrombolysis or thrombectomy is unknown. Methods: Consecutive patients presenting at a single center with newly diagnosed symptomatic ICA occlusion (not involving the circle of Willis) were retrospectively reviewed. Those treated with intravenous thrombolysis or intraarterial thrombolysis/thrombectomy were excluded. Patients were divided into two groups based on whether they experienced recurrent in-hospital stroke. Results: The selected study population (n = 33) represented a small (20.4%) proportion of all newly symptomatic carotid occlusions, who nevertheless had an elevated risk of recurrent stroke during admission (24.2%). Of the variables examined (age, gender, admission National Institutes of Health Stroke Scale score, vascular risk factors, atrial fibrillation, prior stroke/transient ischaemic attack and anticoagulation within 48 h of presentation), only anticoagulation was significantly associated with a lower risk of in-hospital recurrent stroke. Anticoagulated patients showed a decreased incidence of stroke recurrence within the first week (6.7% vs. 38.9%, P = 0.032) and fewer strokes or deaths at 1 month (13.3% vs. 47.1%, P = 0.040). Hemorrhagic transformation was not observed in any patient. On follow-up imaging, ICA recanalization was significantly more frequent in anticoagulated patients (46.2% vs. 9.1%, P = 0.047). Conclusion: Patients with newly diagnosed symptomatic ICA occlusion (not involving the circle of Willis) represent a small but high risk subgroup of patients with carotid occlusion. Early anticoagulation was associated with fewer recurrent strokes and increased ICA recanalization. Larger scale prospective studies may be justified. [ABSTRACT FROM AUTHOR]
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  Data: <i>Copyright of European Journal of Neurology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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        Value: 10.1111/ene.12819
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      – SubjectFull: Stroke
        Type: general
      – SubjectFull: Internal carotid artery
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      – SubjectFull: Arterial occlusions
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