Does acute occlusion of the carotid T invariably have a poor outcome?

OBJECTIVE: To evaluate the prognosis of patients with acute occlusion of the carotid T.

METHODS: The authors studied 42 consecutive patients with acute carotid T occlusion, age 66 (59 to 74) years (median [interquartile range]). T occlusion was diagnosed with transcranial Doppler sonography (TCD; n = 11) and MR (n = 28) or CT (n = 3) angiography. Final infarction size was evaluated on follow-up CT 3 to 7 days after symptom onset and recanalization by follow-up TCD 24 to 36 hours after symptom onset.

RESULTS: NIH Stroke Scale (NIHSS) score on admission was 18 (16 to 20). Final infarct size was one-third or less of the middle cerebral artery (MCA) territory in 11, greater than one-third but less than or equal to two-thirds of the MCA territory in 10, and greater than two-thirds of the MCA territory in 21 patients. Modified Rankin Scale (mRS) score 6 months after stroke onset was 2 in 7 (17%), 3 in 2 (5%), 4 in 13 (31%), 5 in 7 (17%), and 6 in 13 (31%) patients. Complete or partial MCA recanalization within 24 hours after symptom onset was observed in 12 of 18 patients treated with thrombolysis and 4 of the remaining 24 patients (p = 0.001) and was associated with better clinical outcome (mRS 2, recanalization 6/7 [86%]; mRS 3 to 5, recanalization 8/22 [36%]; mRS 6, recanalization 2/13 [15%]; p = 0.01). Recanalization and NIHSS score on admission were independent predictors of outcome.

CONCLUSIONS: Acute carotid T occlusion does not necessarily carry a poor prognosis. IV thrombolysis frequently results in recanalization, which is related to a better clinical outcome and smaller final infarction size.