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Does acute occlusion of the carotid T invariably have a poor outcome?


Georgiadis, D; Oehler, J; Schwarz, S; Rousson, V; Hartmann, M; Schwab, S (2004). Does acute occlusion of the carotid T invariably have a poor outcome? Neurology, 63(1):22-26.

Abstract

OBJECTIVE: To evaluate the prognosis of patients with acute occlusion of the carotid T. METHODS: The authors studied 42 consecutive patients with acute carotid T occlusion, age 66 (59 to 74) years (median [interquartile range]). T occlusion was diagnosed with transcranial Doppler sonography (TCD; n = 11) and MR (n = 28) or CT (n = 3) angiography. Final infarction size was evaluated on follow-up CT 3 to 7 days after symptom onset and recanalization by follow-up TCD 24 to 36 hours after symptom onset. RESULTS: NIH Stroke Scale (NIHSS) score on admission was 18 (16 to 20). Final infarct size was one-third or less of the middle cerebral artery (MCA) territory in 11, greater than one-third but less than or equal to two-thirds of the MCA territory in 10, and greater than two-thirds of the MCA territory in 21 patients. Modified Rankin Scale (mRS) score 6 months after stroke onset was 2 in 7 (17%), 3 in 2 (5%), 4 in 13 (31%), 5 in 7 (17%), and 6 in 13 (31%) patients. Complete or partial MCA recanalization within 24 hours after symptom onset was observed in 12 of 18 patients treated with thrombolysis and 4 of the remaining 24 patients (p = 0.001) and was associated with better clinical outcome (mRS 2, recanalization 6/7 [86%]; mRS 3 to 5, recanalization 8/22 [36%]; mRS 6, recanalization 2/13 [15%]; p = 0.01). Recanalization and NIHSS score on admission were independent predictors of outcome. CONCLUSIONS: Acute carotid T occlusion does not necessarily carry a poor prognosis. IV thrombolysis frequently results in recanalization, which is related to a better clinical outcome and smaller final infarction size.

Abstract

OBJECTIVE: To evaluate the prognosis of patients with acute occlusion of the carotid T. METHODS: The authors studied 42 consecutive patients with acute carotid T occlusion, age 66 (59 to 74) years (median [interquartile range]). T occlusion was diagnosed with transcranial Doppler sonography (TCD; n = 11) and MR (n = 28) or CT (n = 3) angiography. Final infarction size was evaluated on follow-up CT 3 to 7 days after symptom onset and recanalization by follow-up TCD 24 to 36 hours after symptom onset. RESULTS: NIH Stroke Scale (NIHSS) score on admission was 18 (16 to 20). Final infarct size was one-third or less of the middle cerebral artery (MCA) territory in 11, greater than one-third but less than or equal to two-thirds of the MCA territory in 10, and greater than two-thirds of the MCA territory in 21 patients. Modified Rankin Scale (mRS) score 6 months after stroke onset was 2 in 7 (17%), 3 in 2 (5%), 4 in 13 (31%), 5 in 7 (17%), and 6 in 13 (31%) patients. Complete or partial MCA recanalization within 24 hours after symptom onset was observed in 12 of 18 patients treated with thrombolysis and 4 of the remaining 24 patients (p = 0.001) and was associated with better clinical outcome (mRS 2, recanalization 6/7 [86%]; mRS 3 to 5, recanalization 8/22 [36%]; mRS 6, recanalization 2/13 [15%]; p = 0.01). Recanalization and NIHSS score on admission were independent predictors of outcome. CONCLUSIONS: Acute carotid T occlusion does not necessarily carry a poor prognosis. IV thrombolysis frequently results in recanalization, which is related to a better clinical outcome and smaller final infarction size.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > Epidemiology, Biostatistics and Prevention Institute (EBPI)
Dewey Decimal Classification:610 Medicine & health
Date:2004
Deposited On:27 Jun 2009 12:06
Last Modified:05 Apr 2016 13:16
Publisher:American Academy of Neurology
ISSN:0028-3878
Additional Information:© 2004 American Academy of Neurology
Publisher DOI:https://doi.org/10.1212/01.WNL.0000132524.82310.91
Official URL:http://www.neurology.org/cgi/content/full/63/1/22
PubMed ID:15249605

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