Impact of thrombus migration on clinical outcomes in patients with internal carotid artery occlusions and patent middle cerebral artery

Patency of the middle cerebral artery (MCA) in acute ischemic stroke with internal carotid artery (ICA) occlusions is associated with less severe stroke and favorable outcomes. However, thrombus migration to distal intracranial vessels may lead to unfavorable outcomes. We investigated the influence...

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Bibliographic Details
Published in:Journal of the neurological sciences 2020-05, Vol.412, p.116737-116737, Article 116737
Main Authors: Koge, Junpei, Matsumoto, Shoji, Nakahara, Ichiro, Ishii, Akira, Hatano, Taketo, Tanaka, Yujiro, Kondo, Daisuke, Kira, Jun-ichi, Nagata, Izumi
Format: Article
Language:English
Subjects:
Acute ischemic stroke
Aged
Brain Ischemia
Carotid Artery, Internal - diagnostic imaging
Collateral middle cerebral artery flow
Early neurological deterioration
Female
Humans
Internal carotid artery occlusion
Male
Middle Cerebral Artery - diagnostic imaging
Patent middle cerebral artery
Retrospective Studies
Stroke
Thrombosis - complications
Thrombosis - diagnostic imaging
Treatment Outcome
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Summary:Patency of the middle cerebral artery (MCA) in acute ischemic stroke with internal carotid artery (ICA) occlusions is associated with less severe stroke and favorable outcomes. However, thrombus migration to distal intracranial vessels may lead to unfavorable outcomes. We investigated the influence of thrombus migration on clinical outcomes in patients with ICA occlusions and patent MCA. We retrospectively analyzed patients with acute ischemic stroke compromising ICA occlusions and patent MCA who were consecutively admitted to our hospital between January 2006 and March 2016. Thrombus migration was assessed (1) by analyzing the discrepancies in arterial occlusion sites between initial imaging and follow-up imaging and (2) by analyzing how occlusion sites changed during endovascular therapy. Thirty-eight patients (mean age: 74.9 years; 23 men, 15 women, median National Institutes of Health Stroke Scale score = 7.5) with ICA occlusions and patent MCA were ultimately included. We identified 10 patients (26%) with thrombus migration (spontaneous: 3; during endovascular therapy: 7). Patients with thrombus migration had higher rates of unfavorable functional outcomes (modified Rankin Scale scores 3–6 at 90 days) than those without thrombus migration (90% vs. 39%, p 
ISSN:0022-510X
1878-5883
DOI:10.1016/j.jns.2020.116737