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. 2009 Oct;256(10):1728-35.
doi: 10.1007/s00415-009-5194-3. Epub 2009 Jun 2.

Bilateral carotid artery occlusion with transient or moderately disabling ischaemic stroke: clinical features and long-term outcome

Suzanne Persoon  1 , Catharina J M Klijn, Ale Algra, L Jaap Kappelle
Affiliations

Bilateral carotid artery occlusion with transient or moderately disabling ischaemic stroke: clinical features and long-term outcome

Suzanne Persoon et al. J Neurol. 2009 Oct.

Abstract

Information on the prognosis of patients with transient ischaemic attack or moderately disabling ischaemic stroke associated with bilateral internal carotid artery (ICA) occlusion is scarce. We prospectively studied 57 consecutive patients (46 men; mean age 60 +/- 9 years) with bilateral ICA occlusion who had presented with unilateral transient or moderately disabling cerebral or retinal ischaemic symptoms. We determined the long-term risk of recurrent ischaemic stroke and the composite outcome of stroke, myocardial infarction or vascular death. Four patients had a recurrent ischaemic stroke during a mean follow-up of 5.9 years, resulting in an annual stroke rate of 1.2% (95% confidence interval (CI) 0.3-3.1). Risk factors for recurrent ischaemic stroke could not be identified. Eighteen patients suffered a stroke, myocardial infarction or vascular death, resulting in an annual rate for major vascular events of 5.3% (95% CI 3.1-8.3). Age and a history of ischaemic heart disease were significant risk factors for future vascular events. Patients with transient or moderately disabling symptoms of cerebral or retinal ischaemia associated with bilateral ICA occlusion have a relatively low risk of recurrent ischaemic stroke. Although this study was not designed to compare conservative treatment with surgical intervention, the favourable outcome suggests that a policy of medical therapy and control of risk factors may be justified in these patients.

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Figures

Fig. 1
Fig. 1
Angiogram of a 64-year-old man with bilateral ICA occlusion with collateral blood flow towards the left symptomatic hemisphere via the OphthA on the asymptomatic side, who did not suffer a recurrent ischaemic stroke during a follow-up period of 3.2 years; a bilateral ICA occlusion; b selective catheterisation of the left CCA shows filling of only a few MCA branches via the OphthA; c selective catheterisation of the right CCA shows extensive filling of ACA and MCA branches in the right hemisphere and d of the left hemisphere via the right OphthA and subsequently the AComA with filling of ACA and MCA branches
See this image and copyright information in PMC

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