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Occlusion Due to Carotid Artery Dissection
A More Severe Disease Than Previously Suggested
Didier Milhaud, MD;
Gabriel R. de Freitas, MD;
Guy van Melle, PhD;
Julien Bogousslavsky, MD
Arch Neurol. 2002;59:557-561.
Background Stroke due to internal carotid artery dissection is considered to have
a good prognosis.
Objective To determine whether the prognosis of internal carotid artery dissection
is worse than classically reported by comparing the characteristics of patients
who had an acute ischemic stroke admitted to a population-based primary care
center with internal carotid artery occlusion due to either dissection (DO)
or atherothrombosis (AO).
Patients and Methods Among 3502 patients admitted to our population-based primary care center,
DO (n = 73) was diagnosed by angiography or magnetic resonance imaging, while
AO (n = 81) was diagnosed by angiography. The characteristics of patients
with DO or AO were compared using univariate and multivariate analysis.
Results Patients with DO were younger (mean [SD] age, 44.6 [10] vs 60.1 [10]
years, P<.001), had fewer vascular risk factors,
and presented more frequently with global middle cerebral artery territory
involvement (42% vs 17%, P<.05) and less frequently
with watershed infarcts (3% vs 19%, P<.05) than
patients with AO. Unexpectedly, patients with DO were noted to have more severe
clinical impairment, with an increased frequency of decreased consciousness,
and a poorer outcome at 1 month. Multivariate analysis showed that the independent
factors associated with DO were age younger than 55 years, nonsmoker, no history
of hypertension, headache at presentation, and global aphasia.
Conclusions Patients with DO are younger and are initially seen with fewer risk
factors than patients with AO, but their clinical features and prognosis are
worse. Large infarcts involving the whole middle cerebral artery territory
that may be due to the lack of collateral circulation are responsible for
the bad prognosis of patients with DO.
From the Department of Neurology, Centre Hospitalier Universitaire
Vaudois Lausanne (Drs Milhaud, de Freitas, and Bogousslavsky) and the University
Institute of Social and Preventive Medicine (Dr van Melle), Lausanne, Switzerland;
and the Department of Neurology, Centre Hospitalier Universitaire Montpellier,
Montpellier, France (Dr Milhaud).
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