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Ischemic Stroke
Original research
Progression of carotid near-occlusion to complete occlusion: related factors and clinical implications
  1. Andrés García-Pastor1,
  2. Antonio Gil-Núñez1,
  3. José María Ramírez-Moreno2,
  4. Noelia González-Nafría3,
  5. Javier Tejada3,
  6. Francisco Moniche4,
  7. Juan Carlos Portilla-Cuenca5,
  8. Patricia Martínez-Sánchez6,
  9. Blanca Fuentes6,
  10. Miguel Ángel Gamero-García7,
  11. María Alonso de Leciñana8,
  12. Jaime Masjuan8,
  13. David Cánovas9,
  14. Yolanda Aladro10,
  15. Vera Parkhutik11,
  16. Aida Lago11,
  17. Ana María De Arce12,
  18. María Usero-Ruiz13,
  19. Raquel Delgado-Mederos14,
  20. Ana Pampliega15,
  21. Álvaro Ximénez-Carrillo16,
  22. Mónica Bártulos-Iglesias17,
  23. Enrique Castro-Reyes1
  1. 1 Hospital General Universitario Gregorio Marañón, Madrid, Spain
  2. 2 Hospital Universitario Infanta Cristina, Badajoz, Spain
  3. 3 Complejo Asistencial Universitario de León, León, Spain
  4. 4 Hospital Universitario Virgen del Rocio, Seville, Spain
  5. 5 Hospital San Pedro de Alcántara, Caceres, Spain
  6. 6 Hospital Universitario La Paz, Madrid, Spain
  7. 7 Hospital Universitario Virgen Macarena, Sevilla, Spain
  8. 8 Hospital Universitario Ramón y Cajal, Madrid, Spain
  9. 9 Hospital Parc Taulí, Sabadell, Spain
  10. 10 Hospital Universitario de Getafe, Getafe, Spain
  11. 11 Hospital Universitari i Politècnic La Fe, Valencia, Spain
  12. 12 Hospital Universitario de Donostia, San Sebastian, Spain
  13. 13 Hospital Clinico Universitario de Valladolid, Valladolid, Spain
  14. 14 Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
  15. 15 Hospital General Universitari d'Alacant, Alicante, Spain
  16. 16 Hospital Universitario de La Princesa, Madrid, Spain
  17. 17 Complejo Asistencial Univeristario de Burgos, Burgos, Spain
  1. Correspondence to Dr Andrés García-Pastor, Stroke Unit, Neurology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain; angarpas{at}yahoo.es

Abstract

Background The clinical consequences and factors related to the progression from a carotid near-occlusion (CNO) to a complete occlusion are not well established. Our aim is to describe the rate, predictive factors and clinical implications of the progression to complete carotid occlusion (PCCO) in a population of patients with symptomatic CNO.

Methods We conducted a multicenter, nationwide, prospective study from January 2010 to May 2016. Patients with angiography-confirmed CNO were included. We collected information on demographic data, clinical manifestations, radiological and hemodynamic findings, and treatment modalities. A 24 month carotid-imaging follow-up of the CNO was performed.

Results 141 patients were included in the study, and carotid-imaging follow-up was performed in 122 patients. PCCO occurred in 40 patients (32.8%), and was more frequent in medically-treated patients (34 out of 61; 55.7%) compared with patients treated with revascularization (6 out of 61; 9.8%) (p<0.001). 7 of the 40 patients with PCCO (17.5%) suffered ipsilateral symptoms. Factors independently related with PCCO in the multivariate analysis were: age ≥75 years (OR 2.93, 95% CI 1.05 to 8.13), revascularization (OR 0.07, 95% CI 0.02 to 0.20), and collateral circulation through the ipsilateral ophthalmic artery (OR 3.25, 95% CI 1.01 to 10.48).

Conclusions PCCO occurred within 24 months in more than half of the patients under medical treatment. Most episodes of PCCO were not associated with ipsilateral symptoms. Revascularization reduces the risk of PCCO.

  • stroke

http://dx.doi.org/10.1136/neurintsurg-2019-015638

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    Footnotes

    • Twitter @angarpas1

    • Contributors AG-P: study concept and design, acquisition of data, analysis and interpretation, preparation of the manuscript, and study supervision. AG-N: study concept and design, analysis and interpretation, critical revision of the manuscript for important intellectual content, and study supervision. JMRM, NG-N, JT, FM, JCP-C, PM-S, BF, MÁG-G, MAdL, JM, DC-V, YA, VP, AL-M, AMdA-B, MU-R, RD-M, AP, ÁX-C, MB-I, EC-R: acquisition of data and critical revision of the manuscript for important intellectual content.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval This study obtained ethics approval from “Comité de Ética e investigación Clínica Hospital General Universitario Gregorio Marañón”, with ID number of the approval: 122/09. Participants gave informed consent before taking part in the study.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon reasonable request