Early Clinical Signs, Lesion Localization, and Prognostic Factors in Unilateral Symptomatic Internal Carotid Artery Occlusion

• Published in: Journal of stroke and cerebrovascular diseases 2014-08, Vol.23 (7), p.1908-1914
• Main Authors: Güler, Sibel, MD, Utku, Ufuk, MD, Aynaci, Özer, MD
• Format: Article
• Language: English
• Subjects: Aged; Cardiovascular; Carotid Artery, Internal - pathology; Carotid Stenosis - diagnosis; Carotid Stenosis - pathology; Carotid Stenosis - therapy; Cerebral Infarction - diagnosis; Circle of Willis - pathology; Disability Evaluation; Female; Hemodynamics; Humans; infarct pattern; Magnetic Resonance Angiography; Male; Middle Aged; Middle Cerebral Artery - pathology; Nervous System Diseases - etiology; Neurology; Posterior Cerebral Artery - pathology; Prognosis; Stroke - diagnosis; Stroke - therapy; Symptomatic unilateral carotid occlusion; treatment; Willis polygon
• ISSN: 1052-3057; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2014.02.009

Background The aim of this study was to assess infarct localization, clinical signs, and prognostic factors in cases with unilateral symptomatic total internal carotid occlusion. Methods In total, 101 patients who had a diagnosis of symptomatic unilateral carotid occlusion in the Department of Neurology, Trakya University Faculty of Medicine, between January 2008 and May 2012, were included in this study. The relationship between infarct localizations and prognosis of patients was evaluated by cranial magnetic resonance imaging (MRI) and diffusion-weighted MRI. The condition of ipsilateral middle cerebral artery (MCA) and posterior communicating arteries (PCoAs) was assessed by cranial and cervical magnetic resonance angiography besides opposite carotid. Patients were evaluated by modified Rankin Scale in terms of prognosis at discharge and after 3 months. Furthermore, they were evaluated in terms of risk factors, such as cigarette and alcohol use, presence of temporary ischemic attack and stroke history, hypertension, diabetes mellitus, coronary artery disease, previous myocardial infarction, hyperlipidemia, and peripheral vascular disease. Results Territorial infarct was commonly seen as acute ischemic stroke pattern especially in cases with a poor MCA circulation and insufficient collateral circulation. Development of territorial stroke, occlusion of MCA, and nonvisualization of PCoA were found to be associated with poor prognosis. Conclusions In unilateral symptomatic intracranial carotid artery occlusion, poor prognosis and high mortality–associated territorial stroke pattern is frequently observed. Besides, presence of severe stenosis or occlusion and absence of collateral circulation in MCA are associated with poor prognosis.