Carotid dissection with permanent and transient occlusion or severe stenosis: Long-term outcome.
Détails
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Accès restreint UNIL
Etat: Public
Version: Final published version
ID Serval
serval:BIB_69BC6DE466AE
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Carotid dissection with permanent and transient occlusion or severe stenosis: Long-term outcome.
Périodique
Neurology
ISSN
1526-632X (Electronic)
ISSN-L
0028-3878
Statut éditorial
Publié
Date de publication
2003
Peer-reviewed
Oui
Volume
60
Numéro
2
Pages
271-275
Langue
anglais
Notes
Publication types: Journal Article Publication Status: ppublish
Résumé
OBJECTIVE: To compare the rate of ischemic events and intracranial hemorrhage in the long-term follow-up of patients with persistent and transient severe stenosis or occlusion of the internal carotid artery (ICA) due to spontaneous dissection (ICAD).
METHODS: One hundred and sixty-one consecutive patients with unilateral ICAD causing severe stenosis or occlusion were examined clinically and by ultrasound 1 year after symptom onset. Forty-six cases with persistent and 46 age- and latency-matched cases with transient (recanalization complete or less than 50% stenosis) severe stenosis or occlusion of the ICA were enrolled. Nine patients with surgical, endovascular, or fibrinolytic therapy for ICAD or associated stroke were excluded. Antithrombotic therapy was given at the discretion of the treating physician. Clinical follow-ups were done annually.
RESULTS: Antithrombotic therapy and follow-up were similar in patients with permanent (6.2 +/- 3.4 years) and transient (7.2 +/- 4.3 years) severe stenosis or occlusion of the ICA. Cases with permanent carotid stenosis or occlusion showed annual rates of 0.7% for ipsilateral carotid territory stroke and of 1.4% for any stroke. Cases with transient carotid stenosis or occlusion showed annual rates of 0.3% for ipsilateral carotid territory stroke and of 0.6% for any stroke.
CONCLUSIONS: This study suggests that ICAD has a benign long-term prognosis with low rates of ipsilateral carotid territory and any stroke and that the stroke rate in ICAD is not related to the persistence of severe carotid stenosis or occlusion. These results question the rationale of surgical or catheter-based revascularization in patients with ICAD.
METHODS: One hundred and sixty-one consecutive patients with unilateral ICAD causing severe stenosis or occlusion were examined clinically and by ultrasound 1 year after symptom onset. Forty-six cases with persistent and 46 age- and latency-matched cases with transient (recanalization complete or less than 50% stenosis) severe stenosis or occlusion of the ICA were enrolled. Nine patients with surgical, endovascular, or fibrinolytic therapy for ICAD or associated stroke were excluded. Antithrombotic therapy was given at the discretion of the treating physician. Clinical follow-ups were done annually.
RESULTS: Antithrombotic therapy and follow-up were similar in patients with permanent (6.2 +/- 3.4 years) and transient (7.2 +/- 4.3 years) severe stenosis or occlusion of the ICA. Cases with permanent carotid stenosis or occlusion showed annual rates of 0.7% for ipsilateral carotid territory stroke and of 1.4% for any stroke. Cases with transient carotid stenosis or occlusion showed annual rates of 0.3% for ipsilateral carotid territory stroke and of 0.6% for any stroke.
CONCLUSIONS: This study suggests that ICAD has a benign long-term prognosis with low rates of ipsilateral carotid territory and any stroke and that the stroke rate in ICAD is not related to the persistence of severe carotid stenosis or occlusion. These results question the rationale of surgical or catheter-based revascularization in patients with ICAD.
Mots-clé
Adult, Aged, Angiography, Digital Subtraction, Brain/blood supply, Brain/radiography, Carotid Arteries/radiography, Carotid Arteries/ultrasonography, Carotid Artery, Internal, Dissection/diagnosis, Carotid Artery, Internal, Dissection/drug therapy, Carotid Stenosis/classification, Carotid Stenosis/diagnosis, Causality, Comorbidity, Female, Fibrinolytic Agents/therapeutic use, Follow-Up Studies, Humans, Intracranial Hemorrhages/epidemiology, Magnetic Resonance Imaging, Male, Middle Aged, Prognosis, Risk Assessment, Risk Factors, Severity of Illness Index, Stroke/epidemiology, Switzerland/epidemiology, Time, Tomography, X-Ray Computed
Pubmed
Web of science
Création de la notice
08/10/2012 10:21
Dernière modification de la notice
20/08/2019 15:24