Short-term outcomes after symptomatic internal carotid artery occlusion

Abstract

Background and purpose: Previous studies concerning internal carotid artery (ICA) occlusion have focused on long-term prognosis. The purpose of the present study was to evaluate short-term outcomes of patients with symptomatic ICA occlusion.

Methods: We used data from the Registry of the Canadian Stroke Network on consecutive patients presenting to 11 stroke centers in Ontario. We included patients with noncardioembolic ischemic stroke or transient ischemic attack within the anterior circulation. The resulting cohort was divided into 4 groups based on vascular imaging of the ipsilateral extracranial ICA: occlusion, severe stenosis, moderate stenosis, and mild/no stenosis. Logistic regression modeling was used to evaluate the association between the degree of stenosis/occlusion of the symptomatic ICA and a series of short-term outcome measures.

Results: Of the 4144 patients who met study criteria, 283 patients had a symptomatic ICA occlusion. Compared with patients with ICA occlusion, patients with all other degrees of stenosis had a lower risk of in-hospital death, neurological worsening, and poor functional outcome. Particularly, severe stenosis was associated with a lower risk of in-hospital death (adjusted OR, 0.40; 95% CI, 0.20 to 0.79), neurological worsening (adjusted OR, 0.52; 95% CI, 0.34 to 0.78), and poor functional outcome (adjusted OR, 0.62; 95% CI, 0.41 to 0.94) compared with the ICA occlusion group.

Conclusions: The results of our study showed that patients with symptomatic ICA occlusion are at a high risk of adverse outcomes that is as severe, if not worse, than any other degree of ICA stenosis in the short term. Thus, more aggressive management may be warranted for patients with acute, symptomatic ICA occlusion.