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

D. Damania, N. T M Kung, M. Jain, A. R. Jain, J. A. Liew, R. Mangla, G. E. Koch, B. Sahin, A. S. Miranpuri, T. M. Holmquist, R. E. Replogle, C. G. Benesch, A. G. Kelly, B. S. Jahromi*

*Corresponding author for this work

Research output: Contribution to journalArticle

4 Citations (Scopus)

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 intra-arterial 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.

Original languageEnglish (US)
Pages (from-to)127-132
Number of pages6
JournalEuropean Journal of Neurology
Volume23
Issue number1
DOIs
StatePublished - Jan 1 2016

Fingerprint

Stroke
Internal Carotid Artery
Circle of Willis
Thrombectomy
Transient Ischemic Attack
Recurrence
National Institutes of Health (U.S.)
Atrial Fibrillation
Prospective Studies
Incidence
Population

Keywords

  • Anticoagulation
  • Carotid occlusion
  • Ischaemic stroke
  • Outcomes
  • Prevention
  • Reperfusion
  • Treatment

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

Cite this

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. / Factors associated with recurrent stroke and recanalization in patients presenting with isolated symptomatic carotid occlusion. In: European Journal of Neurology. 2016 ; Vol. 23, No. 1. pp. 127-132.
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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 intra-arterial 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.",
keywords = "Anticoagulation, Carotid occlusion, Ischaemic stroke, Outcomes, Prevention, Reperfusion, Treatment",
author = "D. Damania and Kung, {N. T M} and M. Jain and Jain, {A. R.} and Liew, {J. A.} and R. Mangla and Koch, {G. E.} and B. Sahin and Miranpuri, {A. S.} and Holmquist, {T. M.} and Replogle, {R. E.} and Benesch, {C. G.} and Kelly, {A. G.} and Jahromi, {B. S.}",
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Damania, D, Kung, NTM, Jain, M, Jain, AR, Liew, JA, Mangla, R, Koch, GE, Sahin, B, Miranpuri, AS, Holmquist, TM, Replogle, RE, Benesch, CG, Kelly, AG & Jahromi, BS 2016, 'Factors associated with recurrent stroke and recanalization in patients presenting with isolated symptomatic carotid occlusion', European Journal of Neurology, vol. 23, no. 1, pp. 127-132. https://doi.org/10.1111/ene.12819

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

In: European Journal of Neurology, Vol. 23, No. 1, 01.01.2016, p. 127-132.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Factors associated with recurrent stroke and recanalization in patients presenting with isolated symptomatic carotid occlusion

AU - Damania, D.

AU - Kung, N. T M

AU - Jain, M.

AU - Jain, A. R.

AU - Liew, J. A.

AU - Mangla, R.

AU - Koch, G. E.

AU - Sahin, B.

AU - Miranpuri, A. S.

AU - Holmquist, T. M.

AU - Replogle, R. E.

AU - Benesch, C. G.

AU - Kelly, A. G.

AU - Jahromi, B. S.

PY - 2016/1/1

Y1 - 2016/1/1

N2 - 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 intra-arterial 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.

AB - 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 intra-arterial 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.

KW - Anticoagulation

KW - Carotid occlusion

KW - Ischaemic stroke

KW - Outcomes

KW - Prevention

KW - Reperfusion

KW - Treatment

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