Recurrent Stroke in Patients With Symptomatic Carotid Artery Occlusion Is Associated With High-Volume Flow to the Brain and Increased Collateral Circulation

Introduction: In large artery occlusion, endovascular treatment shows better recanalization rate than intravenous tPA alone. In reperfusion therapy, excellent collaterals through the circle of Willis has better prognosis. We hypothesized that intravenous tPA only is comparable to endovascular therapy in carotid occlusion with patent ‘T’. Methods: Between January 2010 and December 2015, in acute stroke patients who had received a reperfusion therapy, carotid artery occlusion with good collateral via the circle of Willis were selected. In all patients, non-contrast CT and CT angiography were conducted before reperfusion therapy and at 24 (+/-6) hours and/or clinical worsening. Stroke severity was assessed with NIHSS at baseline and discharge. The prognosis of reperfusion therapy was assessed by modified Rankin Scales at 3 months. Results: In 529 patients treated by reperfusion therapy, 29 patients (5.5%, male 21, median age 76) had internal carotid artery occlusion with patent ‘T’. In tPA alone (24 patients, 82.8%), baseline NIHSS were non-significantly lower than in endovascular treatment (10 vs 15, p=0.224). Recurrent stroke, which was confirmed with follow up angiography, was developed in 8 of tPA alone. In endovascular treatment, one had a distal embolization. In 22 patients who could be assessed by MRS, 10 patients (45.5%, tPA in 9, IA in 1) had good mRS and 6 patients (27.3%) were expired. Conclusions: Carotid occlusion with good collaterals via the circle of Willis was uncommon. tPA alone resulted in recurrent stroke with clinical worsening. Endovascular treatment may be better option in carotid occlusion with patent ‘T’.

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The Comparison of STA-MCA Bypass and BMT for Symptomatic Internal Carotid Artery Occlusion Disease A Systematic Review and Meta-analysis of Long-term Outcome

10.21203/rs.3.rs-94493/v1 ◽

2020 ◽

Author(s):

Xinyu Yang ◽

Shifei Cai ◽

Hao Fan ◽

Chao Peng ◽

Yuzhang Wu

Keyword(s):

Carotid Artery ◽

Assessment Tool ◽

Statistical Significance ◽

Superficial Temporal Artery ◽

Artery Occlusion ◽

Carotid Artery Occlusion ◽

Term Outcome ◽

Long Term Outcome ◽

Symptomatic Carotid

Abstract Background: Superficial temporal artery (STA) - middle cerebral artery (MCA) bypass surgery now being widely used in moyamoya disease, and its therapeutic value in SICAO remains divergent. Methods: A systematic search was performed in PUBMED, EMBASE and Cochrane Databases in Feb.2020, and updated in Jun.2019. We have strict inclusion and exclusion criteria. Cochrane Bias Risk Assessment Tool was used to assess the quality of included RCTs. Review Manager 5.3 was used for analysis results in terms of comparing the STA-MCA bypass and BMT. For dichotomous variable outcomes, Risk Ratio (RRs) and 95% confidence intervals (95%CIs) were calculated for the assessment.Results: The total patient cohort consisted of 2419 patients, of whom 1188(49.1%) patients had been grouped in STA-MCA bypass, 1231(50.9%) patients had divided into BMT group. Mean follow-up of including patients was 29 months. The RRs of the seven studies was 1.01, and the 95% confidence interval was .89-1.15, with statistical significance, Z=.13, P=.89, sustaining that STA-MCA bypass was not superior to BMT in symptomatic carotid artery occlusion disease.Conclusion: STA-MCA bypass and BMT were associated with similar rates of a composite of long-term stroke. And the risk of long-term overall stroke was mildly higher with BMT. At present, each patient should receive more precise treatment, by reasonably assess the individual differences of each patient to reduce the recurrence rate of stroke.

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