Anterior choroidal artery ischaemic patterns predict outcome of carotid occlusion
- Meng Lee1,2,
- Jeffrey L Saver1,
- Qing Hao1,
- Sidney Starkman1,
- Noriko Salamon3,
- Latisha K Ali1,
- Doojin Kim1,
- Bruce Ovbiagele4,
- Sarah Song1,
- Radoslav Raychev1,
- Hermelind Abcede1,
- Rana Fiaz1,
- David S Liebeskind1,
- for the UCLA Stroke Investigators
- 1Department of Neurology, Stroke Center, University of California, Los Angeles, California, USA
- 2Department of Neurology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Chiayi, Taiwan
- 3Department of Radiology, University of California, Los Angeles, California, USA
- 4Department of Neuroscience, Stroke Center, University of California, San Diego, California, USA
- Correspondence to Dr David S Liebeskind, UCLA Stroke Center, 710 Westwood Plaza, Los Angeles, CA 90095, USA;
Contributors JLS and DSL designed the study. ML, JLS, QH, SS, NS, LKA, DK, BO, SS, RR, HA, RF and DSL participated in the data collection and extraction. ML did the statistical analysis with guidance from JLS and DSL. ML wrote the first draft of the report, and JLS and DSL did the major revision. All other authors commented on the draft and approved the final version. We thank Dr. Yen-Chu Huang for editing figure 1.
- Received 22 September 2011
- Revised 7 December 2011
- Accepted 7 March 2012
- Published Online First 4 April 2012
Objective To investigate whether anterior choroidal artery (AChA) territory sparing or AChA infarction restricted to the medial temporal lobe (MT), implying good collateral status, predicts good outcome, defined as modified Rankin Scale 0–2, at discharge in acute internal carotid artery (ICA) occlusion.
Methods The authors studied consecutive patients with acute ICA occlusion admitted to an academic medical centre between January 2002 and August 2010, who underwent MRI followed by conventional angiography. The pattern of AChA involvement on initial diffusion-weighted imaging was dichotomised as spared or MT only versus other partial or full. The association of AChA infarct patterns and good outcome at discharge was calculated by multivariate logistic regression with adjustment.
Results For the 60 patients meeting entry criteria, mean age was 68.3 years and median admission NIH Stroke Scale score was 19. AChA territory was spared or restricted to the MT in 27 patients and other partially involved or fully involved in 33 patients. AChA territory spared or ischaemia restricted to MT only, compared with other partial infarct patterns or full infarct, was independently associated with good discharge outcome (44.4% vs 12.1%, OR 7.24, 95% CI 1.32 to 39.89, p=0.023).
Conclusion In acute ICA occlusion, the absence of AChA infarction or restriction to the MT is an independent predictor of good discharge outcome. Analysis of AChA infarct patterns may improve early prognostication and decision-making.
- Internal carotid artery occlusion
- anterior choroidal artery
- modified Rankin Scale
- acute ischaemic stroke
- diffusion weighted imaging
- speech therapy
- cerebrovascular disease
- collateral circulation
Funding ML (CMRPG 660311, Taiwan), JLS (NIH SPOTRIAS), DSL (NIH-NINDS Awards K23NS054084 and P50NS044378) and BO (UCLA-RCMAR under NIH/NIA Grant P30-AG021684).
Competing interests None.
Patient consent Exempt from consent.
Ethics approval This study was approved by the UCLA institutional review board.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Data sharing is covered by the institutional clinical research policies of UCLA Stroke Center.