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Symptomatic isolated internal carotid artery occlusion with initial medical management: a monocentric cohort

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Abstract

Background

Symptomatic isolated carotid artery occlusions (ICAO) can lead to disability, recurrent stroke, and mortality, but natural history and best therapeutic management remain poorly known. The objective of this study was to describe our cohort of ICAO patients with an initial medical management.

Methods

We conducted a retrospective study including consecutive patients admitted to our Comprehensive Stroke Center for ICAO within 24 h after stroke onset between January 2016 and September 2018. Patients with immediate endovascular therapy (EVT) were excluded. Medical treatment was based on anticoagulation (delayed by 24 h if intravenous thrombolysis was performed). ‘Rescue’ EVT was considered if first-week neurological deterioration (FWND) occurred.

Results

Fifty-six patients were included, with a median National Institutes of Health Stroke Scale (NIHSS) of 3. Eleven patients (20%) had FWND during the first week, four benefited from rescue EVT. A mismatch volume > 40 cc on initial perfusion imaging and FLAIR vascular hyperintensities were associated with FWND (p = 0.007 and p = 0.009, respectively). Thirty-eight patients (69%) had a good outcome (modified Rankin Scale mRS 0–2) at 3 months, 36 (69%) had an excellent outcome (mRS 0–1). Seventeen patients (38%) had carotid patency on 3-month control imaging. Recurrences occurred in six (13%) of the survivors (mean follow-up: 13.6 months).

Conclusion

Our results suggest that the prognosis of patients with acute ICAO was favorable with a medical strategy, albeit a substantial rate of FWND and recurrence. FWND was well predicted by a core-perfusion mismatch volume > 40 cc. Randomized controlled trials are necessary to assess the benefit of EVT in ICAO.

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Acknowledgements

Authors would like to thank Mrs Hattinguais Jessica for assistance in data collection.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Department of Neurology, CHRU Gui de Chauliac, 80 Avenue Augustin Fliche, 34295, Montpellier, France

    Adrien Ter Schiphorst, Nicolas Gaillard, Isabelle Mourand, Lucas Corti, Mahmoud Charif, Xavier Ayrignac, Anaïs Lippi & Caroline Arquizan

  2. Department of Neuroradiology, CHRU Gui de Chauliac, Montpellier, France

    Cyril Dargazanli & Vincent Costalat

  3. Department of Neurology, CHRU Carémeau, Nîmes, France

    Stéphane Bouly

  4. Department of Neurology, CH de Béziers, Béziers, France

    Lalu Thibault

  5. Department of Neurology, CH de Perpignan, Perpignan, France

    Denis Sablot

  6. Department of Neurology, CH de Narbonne, Narbonne, France

    Genevieve Blanchet-Fourcade

  7. Department of Neurology, Clinique du Millénaire, Montpellier, France

    Nicolas Landragin

  8. Clinical Research and Epidemiology Unit, CHU, University Montpellier, Montpellier, France

    Claire Duflos

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  1. Adrien Ter Schiphorst
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  16. Caroline Arquizan
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Contributions

CA and AS planned the study data collection, identified the patient cohort, gathered the data, and drafted the manuscript; CD and AS did the statistical analysis. All authors contributed to data collection, made suggestions on analysis, and approved the final manuscript. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Caroline Arquizan.

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Conflicts of interest

The authors declare that they have no conflict of interest.

Ethics approval

This study has been approved by local institutional review board (IRB 202000337) of Montpellier University Hospital, waiving need for informed consent due to the observational design.

Consent for publication

Informed consent has been waving by local IRB due to the study observational design.

Availability of data and material

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Ter Schiphorst, A., Gaillard, N., Dargazanli, C. et al. Symptomatic isolated internal carotid artery occlusion with initial medical management: a monocentric cohort. J Neurol 268, 346–355 (2021). https://doi.org/10.1007/s00415-020-10118-9

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  • DOI: https://doi.org/10.1007/s00415-020-10118-9

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