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Research paper
Factors associated with early outcome in patients with large-vessel carotid strokes
  1. Elisa Cuadrado-Godia1,2,
  2. Sara Jimena1,2,
  3. Angel Ois1,2,
  4. Ana Rodríguez-Campello1,2,
  5. Eva Giralt-Steinhauer1,2,
  6. Carol Soriano-Tarraga2,
  7. Jordi Jiménez-Conde1,2,
  8. José Enrique Martínez-Rodríguez1,2,
  9. Jaume Capellades3,
  10. Jaume Roquer1,2
  1. 1Neurology Department, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
  2. 2Vascular Research Program, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
  3. 3Neuroradiology Department, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
  1. Correspondence to Elisa Cuadrado-Godia, Neurology Department, Hospital del Mar, Universitat Autònoma de Barcelona, Vascular Research Program, IMIM, Passeig Marítim 25–29, Barcelona 08003, Spain; Ecuadrado{at}hospitaldelmar.cat

Abstract

Objective To describe the severity and early neurological deterioration (END) in patients with symptomatic carotid stenosis and to analyse the influence of related factors.

Methods Observational cohort study of patients with ischaemic stroke, ipsilateral carotid stenosis and without evidence of cardiac sources of embolism prospectively recorded since January 2003 to January 2012. Initial severity was categorised as mild (NIH stroke scale (NIHSS) ≤7), moderate (NIHSS 8–14) or high (NIHSS >14). Logistic ordinal and regression analyses were performed for stroke severity and END risk.

Results Of 2332 ischaemic strokes attended, 338 patients were included. Stroke severity was mild in 254 (75.1%) cases, moderate in 53 (15.7%) and severe in 31 (9.2%). Adjusted ORs (95% CI) for stroke severity were: degree of carotid stenosis, 2.20 (1.55 to 3.11, p<0.001); intracranial disease, 1.93 (1.18 to 3.17, p=0.009); plasma glucose, 1.01 (1.003 to 1.02, p<0.001); and previous transient ischaemic attack (TIA), 0.37 (0.17 to 0.82, p=0.014). 78 patients (23.1%) had END. Multivariate analysis showed independent association between END and degree of carotid stenosis (OR 1.64, 1.14 to 2.34, p=0.007), previous TIA (OR 2.40, 1.25 to 4.57, p=0.008) and mean arterial pressure (OR 1.02, 1.01 to 1.04, p=0.003).

Conclusions Strokes due to large vessel disease in the carotid artery are in general of mild severity and have a high rate of END. The degree of stenosis has a clear association with higher severity and END risk.

  • Stroke
  • Ultrasonic Angiology

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