Importance of Hemodynamic Factors in the Prognosis of Symptomatic Carotid Occlusion

Grubb, Robert L.; Derdeyn, Colin P.; Fritsch, Susanne; Carpenter, David; Yundt, Kent D.; Videen, Tom O.; Spitznagel, Edward L.; Powers, William J.

doi:10.1001/jama.280.12.1055

Cited by 699 publications

(293 citation statements)

References 25 publications

Supporting

Mentioning

272

Contrasting

Unclassified

Order By: Relevance

“…Patients with leptomeningeal collaterals on angiography had an approximately four times higher risk of recurrent ischemic events, than those without this type of collateral pathway [36]. Positron emission tomography assessment of increased oxygen extraction fraction can identify patients with ICA occlusion who are at high risk for ischemic stroke [37, 38]. We do not have data regarding the presence of impaired cerebral blood flow other than that only 13.5% of the patients with ICA occlusion had watershed infarcts.…”

Section: Discussionmentioning

confidence: 99%

Outcome in Patients with Stroke Associated with Internal Carotid Artery Occlusion

et al. 2005

View full text Add to dashboard Cite

Background: The clinical outcome in patients with stroke associated with internal carotid artery (ICA) occlusion is poor, although a minority may recover without dependency. The purposes of this study were (1) to assess the predictive factors of adverse outcome in patients with stroke associated with an occlusion of the ICA and (2) to evaluate the rate of spontaneous recanalization of an occluded ICA. Methods: A total of 177 consecutive patients with first-ever ischemic stroke associated with ICA occlusion were prospectively examined from the Perugia Stroke Registry. Mean age was 71.4 ± 14.3 years; 53% were males. Multiple regression models were used to analyze predictors of mortality, dependency and ipsilateral stroke recurrence. Results: The most probable cause of occlusion was atherosclerosis in 65%, cardioembolism in 22%, dissection in 9% and other causes in 4%. Thirty percent of the patients died within 30 days. After a mean follow-up of 420 days (range 1–1,970 days), 45% of the patients had died and 75% had died or were disabled. Another 6% of the patients had a recurrent stroke ipsilateral to the occluded carotid artery. Age was the only predictor of 30-day mortality (77.7 ± 9.7 vs. 68.7 ± 15.2 years; p = 0.03) and of long-term mortality or disability (p < 0.003). Hypertension (OR 0.42; 95% CI 0.17–1.00; p = 0.05) was associated with a better outcome within 30 days from stroke onset. Previous ipsilateral transient ischemic attack (OR 0.24; 95% CI 0.06–0.89; p = 0.03) and hyperlipidemia (OR 0.38; 95% CI 0.15–0.99; p = 0.049) were predictors of a better outcome with respect to long-term mortality or disability. No predictors of ipsilateral stroke recurrence were found. One hundred and five out of 177 patients had adequate follow-up ultrasound data. After a mean follow-up of 1.8 years, 10 patients had recanalization of the occluded ICA (2/71 atherosclerosis, 3/19 cardioembolism and 5/15 dissection). Conclusions: After a mean follow-up of 1.2 years, 45% of the patients with stroke associated with ICA occlusion had died, while 75% had died or were functionally dependent. The presence of either previous ipsilateral transient ischemic attack, hypertension or hyperlipidemia was associated with a favorable outcome. Recanalization of an occluded ICA occurred in a minority of patients and it was associated with cardioembolism and with arterial dissection.

show abstract

Section: Discussionmentioning

confidence: 99%

Outcome in Patients with Stroke Associated with Internal Carotid Artery Occlusion

et al. 2005

View full text Add to dashboard Cite

show abstract

“…After exclusion of patients as described in the Methods section, the 44 studies consisted of 3,457 patients (range 7–714 per study; 2,902 patients with extracranial ICA occlusion, 224 with intracranial ICA stenosis or occlusion, 293 patients with stenosis or occlusion of the MCA, whereas in 38 patients the location of the arterial lesion was not specified), with 12,457 patient-years of follow-up (range 10–3,320 per study). Fifteen studies had a prospective design [1, 4, 5, 6, 9, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20]and 29 were retrospective [3, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48]. Thirty-four studies included patients only if the carotid or MCA lesion had been demonstrated by angiography, whereas in 8 studies the carotid lesion could also be demonstrated by duplex [4, 6, 17, 18, 41, 43, 46, 48]or magnetic resonance angiography [4].…”

Section: Resultsmentioning

confidence: 99%

“…Several studies have shown that a reduced CBF or an exhausted autoregulation of the CBF can predict recurrent ischaemic stroke in patients with an ICA occlusion [3, 4, 5, 6]. Based on these findings, it has been argued that some patients with symptomatic ICA occlusion, especially those with a low flow state of the brain, may benefit from extracranial-intracranial (EC/IC) bypass surgery [2, 4, 7, 8].…”

Section: Introductionmentioning

confidence: 99%

“…Based on these findings, it has been argued that some patients with symptomatic ICA occlusion, especially those with a low flow state of the brain, may benefit from extracranial-intracranial (EC/IC) bypass surgery [2, 4, 7, 8]. The large EC/IC bypass study did not show any benefit of EC/IC bypass surgery in preventing recurrent stroke [9], but haemodynamic measures were not taken into account.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Outcome in Patients with Symptomatic Occlusion of the Internal Carotid Artery or Intracranial Arterial Lesions: A Meta-Analysis of the Role of Baseline Characteristics and Type of Antithrombotic Treatment

et al. 2001

View full text Add to dashboard Cite

Objectives: We performed a systematic review of the literature to assess the impact of potential risk factors of recurrent stroke other than a compromised cerebral blood flow in patients with carotid occlusion or intracranial arterial lesions. In addition, we investigated the effect of treatment with aspirin or oral anticoagulation on recurrent stroke rate and assessed whether the incidence of recurrent stroke has decreased over the years. Methods: We searched Medline (1966 and onwards) and reference lists of identified articles for papers reporting on the recurrent stroke risk in patients with carotid occlusion or intracranial arterial lesions. Two authors independently extracted information from all papers. The influence of study characteristics on the risk of the endpoints ‘recurrent stroke’, ‘ipsilateral stroke’ and ‘vascular death’ was determined by Poisson regression analysis. Rate ratios were calculated per 10 percentage points increase of a characteristic. Results and Conclusions: Patients with intracranial carotid stenosis or occlusion had a higher rate of recurrent stroke (rate ratio 1.09; 95% CI 1.05–1.14) than patients with extracranial carotid occlusion or middle cerebral artery stenosis or occlusion. In patients with bilateral carotid occlusion the rate was lower (rate ratio 0.82; 95% CI 0.68–0.98). No other vascular risk factors than hypertension (rate ratio 1.23; 95% CI 1.07–1.41) could be shown to increase the rate of recurrent stroke. Oral anticoagulation but not aspirin had a protective effect on the incidence of recurrent stroke (rate ratio 0.86; 95% CI 0.79–0.93). The reported rates of recurrent stroke in patients with symptomatic occlusion of the internal carotid artery or intracranial arterial lesions have not decreased over the years.

show abstract

“…Carotid ultrasound examination is of great value since it is noninvasive, and can reflect the degree of CAA stenosis, plaque characteristics and IMT. On the basis of CAA, the carotid stenosis decreased distal blood flow and formation of thrombosis which is an important mechanism of cerebral infarction [13] [14]. Hypoechoic plaques are mainly composed by the deposition of cholesterol, necrosis tissue and plaque bleeding, a type of plaque with instability [15].…”

Section: Discussionmentioning

confidence: 99%

Relation between Carotid Stenosis Severity, Plaque Echogenicity Characteristics and IMT Assessed by Ultrasound in the Community Population of Southern China

Liao¹,

Hong²,

Wang³

2015

OALib

View full text Add to dashboard Cite

Carotid artery atherosclerosis (CAA) is one of the major high-risk mechanisms of stroke. Relationship between IMT, carotid plaque echogenicity and carotid stenosis assessed by ultrasound has not been systemically studied, especially in subjects with mild to moderate carotid stenosis. In this study we measured these 3 different ultrasound-derived quantitative traits concurrently in the community population of southern China and compared their associations. We found that IMTmean in the non-stenosis group (0%), <30% group and ≥30% group were 0.72 ± 0.11 mm, 0.85 ± 0.13 mm, 0.90 ± 0.17 mm respectively. IMT mean of the <30% group and ≥30% group were higher than that of 0% group (P < 0.01), ≥30% group was higher than <30% group (P < 0.01). IMT mean in the no-plaque group, hyperechoic group and hypoechoic group were 0.75 ± 0.13 mm, 0.87 ± 0.17 mm, 0.84 ± 0.15 mm respectively. IMT mean of the hyperechoic group and the hypoechoic group was higher than that of the no-plaque group (P < 0.01), IMT mean of the hypoechoic group was lower than that of the hyperechoic group, though with no statistic significance (P = 0.58). The proportion of hyperechoic or hypoechoic plaque in the <30% group was higher than that in the non-stenosis group (P < 0.01), as well as proportion of hypoechoic plaque in the ≥30% group was higher than that in the <30% group (P < 0.01). Our study indicated that there is definite correlation between stenosis severity, plaque echogenicity characteristics and IMT in evaluation the extent of CAA with ultrasound. The result suggests that the 3 different ultrasound-derived quantitative traits, are a progressing process, and this process increases the risk of stroke, thus medical treatment especially stabilizing the plaques is necessary.

show abstract

Importance of Hemodynamic Factors in the Prognosis of Symptomatic Carotid Occlusion

Cited by 699 publications

References 25 publications

Outcome in Patients with Stroke Associated with Internal Carotid Artery Occlusion

Outcome in Patients with Stroke Associated with Internal Carotid Artery Occlusion

Outcome in Patients with Symptomatic Occlusion of the Internal Carotid Artery or Intracranial Arterial Lesions: A Meta-Analysis of the Role of Baseline Characteristics and Type of Antithrombotic Treatment

Relation between Carotid Stenosis Severity, Plaque Echogenicity Characteristics and IMT Assessed by Ultrasound in the Community Population of Southern China

Contact Info

Product

Resources

About