Occlusion due to carotid artery dissection: a more severe disease than previously suggested.

Details

Serval ID
serval:BIB_24972
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Occlusion due to carotid artery dissection: a more severe disease than previously suggested.
Journal
Archives of Neurology
Author(s)
Milhaud D., de Freitas G.R., van Melle G., Bogousslavsky J.
ISSN
0003-9942
Publication state
Published
Issued date
2002
Volume
59
Number
4
Pages
557-561
Language
english
Abstract
BACKGROUND: Stroke due to internal carotid artery dissection is considered to have a good prognosis. OBJECTIVE: To determine whether the prognosis of internal carotid artery dissection is worse than classically reported by comparing the characteristics of patients who had an acute ischemic stroke admitted to a population-based primary care center with internal carotid artery occlusion due to either dissection (DO) or atherothrombosis (AO). PATIENTS AND METHODS: Among 3502 patients admitted to our population-based primary care center, DO (n = 73) was diagnosed by angiography or magnetic resonance imaging, while AO (n = 81) was diagnosed by angiography. The characteristics of patients with DO or AO were compared using univariate and multivariate analysis. RESULTS: Patients with DO were younger (mean [SD] age, 44.6 [10] vs. 60.1 [10] years, P<.001), had fewer vascular risk factors, and presented more frequently with global middle cerebral artery territory involvement (42% vs. 17%, P<.05) and less frequently with watershed infarcts (3% vs. 19%, P<.05) than patients with AO. Unexpectedly, patients with DO were noted to have more severe clinical impairment, with an increased frequency of decreased consciousness, and a poorer outcome at 1 month. Multivariate analysis showed that the independent factors associated with DO were age younger than 55 years, nonsmoker, no history of hypertension, headache at presentation, and global aphasia. CONCLUSIONS: Patients with DO are younger and are initially seen with fewer risk factors than patients with AO, but their clinical features and prognosis are worse. Large infarcts involving the whole middle cerebral artery territory that may be due to the lack of collateral circulation are responsible for the bad prognosis of patients with DO.
Keywords
Adult, Aged, Analysis of Variance, Angiography, Brain Ischemia/complications, Brain Ischemia/etiology, Carotid Artery Thrombosis/complications, Carotid Artery Thrombosis/radiography, Carotid Artery, Internal, Dissection/complications, Carotid Artery, Internal, Dissection/radiography, Carotid Stenosis/etiology, Carotid Stenosis/radiography, Female, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Prognosis, Risk Factors, Severity of Illness Index, Stroke/etiology, Stroke/radiography
Pubmed
Web of science
Open Access
Yes
Create date
19/11/2007 12:21
Last modification date
20/08/2019 13:02
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