Purpose

Intracranial carotid artery occlusion represents an underinvestigated cause of acute ischemic stroke as well as an indication for mechanical thrombectomy. We investigated baseline and procedural characteristics, outcomes and predictors of outcome in patients with acute ischemic stroke secondary to intracranial carotid artery occlusion.

Methods

A retrospective analysis of the Italian Registry of Endovascular Treatment in Acute Stroke was performed. Patients with intracranial carotid artery occlusion (infraclinoid and supraclinoid) with or without cervical artery occlusion but with patent intracranial arteries were included. The 3‑month functional independence, mortality, successful reperfusion and symptomatic intracranial hemorrhage were evaluated.

Results

Intracranial carotid artery occlusion with patent intracranial arteries was diagnosed in 387 out of 4940 (7.8%) patients. The median age was 74 years and median baseline National Institute of Health Stroke Scale (NIHSS) was 18. Functional independence was achieved in 130 (34%) patients, successful reperfusion in 289 (75%) and symptomatic intracranial hemorrhage in 33 (9%), whereas mortality occurred in 111 (29%) patients. In univariate analysis functional independence was associated with lower age, lower NIHSS at presentation, higher rate of successful reperfusion and lower rate of symptomatic intracranial hemorrhage. Multivariable regression analysis found age (odds ratio, OR:1.03; P = 0.006), NIHSS at presentation (OR: 1.07; P < 0.001), diabetes (OR: 2.60; P = 0.002), successful reperfusion (OR:0.20; P < 0.001) and symptomatic intracranial hemorrhage (OR: 4.17; P < 0.001) as the best independent predictors of outcome.

Conclusion

Our study showed a not negligible rate of intracranial carotid artery occlusion with patent intracranial arteries, presenting mostly as severe stroke, with an acceptable rate of 3‑month functional independence. Age, NIHSS at presentation and successful reperfusion were the best independent predictors of outcome.

中文翻译：

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急性颅内颈动脉闭塞的机械取栓治疗颅内动脉通畅

目的

颅内颈动脉闭塞是急性缺血性卒中的一个未充分研究的原因，也是机械取栓的指征。我们调查了继发于颅内颈动脉闭塞的急性缺血性卒中患者的基线和手术特征、结局和结局预测因素。

方法

对意大利急性卒中血管内治疗登记处进行了回顾性分析。包括颅内颈动脉闭塞（infraclinoid 和supraclinoid），伴或不伴颈动脉闭塞但颅内动脉通畅的患者。评估了 3 个月的功能独立性、死亡率、成功再灌注和有症状的颅内出血。

结果

4940 名患者中有 387 名 (7.8%) 被诊断为颅内颈动脉闭塞并伴有开放的颅内动脉。中位年龄为 74 岁，美国国立卫生研究院卒中量表 (NIHSS) 的中位基线为 18 岁。 130 名 (34%) 患者实现功能独立，289 名 (75%) 成功再灌注，33 名 (9%) 出现症状性颅内出血)，而死亡率发生在 111 (29%) 名患者中。在单变量分析中，功能独立性与年龄较低、就诊时 NIHSS 较低、再灌注成功率较高和症状性颅内出血率较低有关。多变量回归分析发现年龄（比值比，OR：1.03；P  = 0.006），就诊时 NIHSS（OR：1.07；P  < 0.001），糖尿病（OR：2.60；P = 0.002）、成功再灌注（OR：0.20；P  < 0.001）和有症状的颅内出血（OR：4.17；P  < 0.001）作为结果的最佳独立预测因子。

结论

我们的研究表明，颅内颈动脉闭塞的比率不容忽视，主要表现为严重的中风，3 个月的功能独立性是可以接受的。年龄、就诊时的 NIHSS 和成功再灌注是预后的最佳独立预测因素。