Residual High-Grade Stenosis After Recanalization of Extracranial Carotid Occlusion in Acute Ischemic Stroke. Issue 1 (January 2015)

• Record Type: Journal Article
• Authors: Luitse, Merel J.A.; Velthuis, Birgitta K.; Dauwan, Meenakshi; Dankbaar, Jan Willem; Biessels, Geert Jan; Kappelle, L. Jaap; Majoie, C.B.; Roos, Y.B.; Duijm, L.E.; Keizer, K.; van der Lugt, A.; Dippel, D.W.; Droogh-de Greve, K.E.; Bienfait, H.P.; van Walderveen, M.A.; Wermer, M.J.; Lycklama à Nijeholt, G.J.; Boiten, J.; Duyndam, D.A.; Kwa, V.I.; Meijer, F.J.; van Dijk, E.J.; Kesselring, F.O.; Hofmeijer, J.; Vos, J.A.; Schonewille, W.J.; van Rooij, W.J.; de Kort, P.L.; Pleiter, C.C.; Bakker, S.L.; Bot, J.C.; Visser, M.C.; van der Schaaf, I.C.; Mali, W.P.; van Seeters, T.; Horsch, A.D.; Niesten, J.M.; van der Graaf, Y.;
• Is Part Of: Stroke. Volume 46:Issue 1(2015)
• Publication Date: 2015-01
• Subjects: angiography, digital subtraction -- carotid stenosis -- stroke; Cerebrovascular disease -- Periodicals; Cerebral circulation -- Periodicals; 616.81
• DOI: 10.1161/STROKEAHA.114.007169
• Languages: English
• ISSNs: 0039-2499

Abstract

Abstract : Background and Purpose—: Residual stenosis after recanalization of an acute symptomatic extracranial occlusion of the internal carotid artery (ICA) might be an indication for carotid endarterectomy. We evaluated the proportion of residual high-grade stenosis (≥70%, near occlusions not included) on follow-up imaging in a consecutive series of patients with an acute symptomatic occlusion of the extracranial ICA. Methods—: We included patients participating in the Dutch Acute Stroke Study (DUST), who had an acute symptomatic occlusion of the extracranial ICA that was diagnosed on computed tomographic angiography within 9 hours after onset of neurological symptoms. Follow-up imaging of the carotid artery had to be available within 7 days after admission. Results—: Of the 1021 patients participating in DUST between May 2009 and May 2013, an acute symptomatic occlusion of the extracranial ICA was found in 126 (12.3%) patients. Follow-up imaging was available in 86 (68.3%) of these patients. At follow-up, a residual stenosis of <30% was found in 15 (17.4%; 95% confidence interval, 10.8–26.9) patients, a 30% to 49% stenosis in 3 (3.5%; 95% confidence interval, 0.8–10.2) patients, a 50% to 69% stenosis in 2 (2.3%; 95% confidence interval, 0.1–8.6) patients, and a ≥70% stenosis in 14 (16.3%; 95% confidence interval, 9.8–25.6) patients. A near or persistent occlusion was present in the remaining 52 (60.5%) patients. Conclusions—: A residual high-grade stenosis of the extracranial ICA occurs in 1 of 6 patients with a symptomatic occlusion in the acute stage of cerebral ischemia. Because this may have implications for secondary prevention, we recommend follow-up imaging in these patients within a week after the event. Clinical Trial Registration—: URL:http://www.clinicaltrials.gov . Unique identifier: NCT00880113. Abstract : Supplemental Digital Content is available in the text.