Prognosis of Untreated Strokes Due to Anterior Circulation Proximal Intracranial Arterial Occlusions Detected by Use of Computed Tomography Angiography

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dc.contributor.author Lima, Fabricio O.
dc.contributor.author Furie, Karen L.
dc.contributor.author Silva, Gisele S. [UNIFESP]
dc.contributor.author Lev, Michael H.
dc.contributor.author Camargo, Erica C. S.
dc.contributor.author Singhal, Aneesh B.
dc.contributor.author Harris, Gordon J.
dc.contributor.author Halpern, Elkan F.
dc.contributor.author Koroshetz, Walter J.
dc.contributor.author Smith, Wade S.
dc.contributor.author Nogueira, Raul G.
dc.date.accessioned 2016-01-24T14:35:12Z
dc.date.available 2016-01-24T14:35:12Z
dc.date.issued 2014-02-01
dc.identifier http://dx.doi.org/10.1001/jamaneurol.2013.5007
dc.identifier.citation Jama Neurology. Chicago: Amer Medical Assoc, v. 71, n. 2, p. 151-157, 2014.
dc.identifier.issn 2168-6149
dc.identifier.uri http://repositorio.unifesp.br/handle/11600/37354
dc.description.abstract IMPORTANCE Limited data exist regarding the natural history of proximal intracranial arterial occlusions.OBJECTIVE To investigate the outcomes of patients who had an acute ischemic stroke attributed to an anterior circulation proximal intracranial arterial occlusion.DESIGN, SETTING, and PARTICIPANTS A prospective cohort study at 2 university-based hospitals from 2003 to 2005 in which nonenhanced computed tomography scans and computed tomography angiograms were obtained at admission of all adult patients suspected of having an ischemic stroke in the first 24 hours of symptom onset.EXPOSURE Anterior circulation proximal intracranial arterial occlusion.MAIN OUTCOMES and MEASURES Frequency of good outcome (defined as a modified Rankin Scale score of <= 2) and mortality at 6 months.RESULTS A total of 126 patients with a unilateral complete occlusion of the intracranial internal carotid artery (ICA; 26 patients: median National Institutes of Health Stroke Scale [NIHSS] score, 11 [interquartile range, 5-17]), of the M1 segment of the middle cerebral artery (MCA; 52 patients: median NIHSS score, 13 [interquartile range, 6-16]), or of the M2 segment of the MCA (48 patients: median NIHSS score, 7 [interquartile range, 4-15]) were included. of these 3 groups of patients, 10 (38.5%), 20 (38.5%), and 26 (54.2%) with ICA, MCA-M1, and MCA-M2 occlusions, respectively, achieved a modified Rankin Scale score of 2 or less, and 6 (23.1%), 12 (23.1%), and 10 (20.8%) were dead at 6 months. Worse outcomes were seen in patients with a baseline NIHSS score of 10 or higher, with a modified Rankin Scale score of 2 or less achieved in only 7.1% (1 of 14), 23.5% (8 of 34), and 22.7% (5 of 22) of patients and mortality rates of 35.7% (5 of 14), 32.4% (11 of 34), and 40.9% (9 of 22) among patients with ICA, MCA-M1, and MCA-M2 occlusions, respectively. Age (odds ratio, 0.94 [95% CI, 0.91-0.98]), NIHSS score (odds ratio, 0.73 [95% CI, 0.64-0.83]), and strength of leptomeningeal collaterals (odds ratio, 2.37 [95% CI, 1.08-5.20]) were independently associated with outcome, whereas the level of proximal intracranial arterial occlusion (ICA vs MCA-M1 vs MCA-M2) was not.CONCLUSIONS and RELEVANCE the natural history of proximal intracranial arterial occlusion is variable, with poor outcomes overall. Stroke severity and collateral flow appear to be more important than the level of proximal intracranial arterial occlusion in determining outcomes. Our results provide useful data for proper patient selection and sample size calculations in the design of new clinical trials aimed at recanalization therapies. en
dc.description.sponsorship US Department of Health and Human Services/Agency for Healthcare Research and Quality
dc.format.extent 151-157
dc.language.iso eng
dc.publisher Amer Medical Assoc
dc.relation.ispartof Jama Neurology
dc.rights Acesso restrito
dc.title Prognosis of Untreated Strokes Due to Anterior Circulation Proximal Intracranial Arterial Occlusions Detected by Use of Computed Tomography Angiography en
dc.type Artigo
dc.contributor.institution Universidade Estadual de Campinas (UNICAMP)
dc.contributor.institution Brown Univ
dc.contributor.institution Universidade Federal de São Paulo (UNIFESP)
dc.contributor.institution Massachusetts Gen Hosp
dc.contributor.institution Boston Univ
dc.contributor.institution NINDS
dc.contributor.institution Univ Calif San Francisco
dc.contributor.institution Emory Univ
dc.description.affiliation Univ Estadual Campinas, Dept Neurol, Neurovasc Serv, São Paulo, Brazil
dc.description.affiliation Brown Univ, Dept Neurol, Providence, RI 02912 USA
dc.description.affiliation Universidade Federal de São Paulo, Dept Neurol, Neurovasc Serv, São Paulo, Brazil
dc.description.affiliation Massachusetts Gen Hosp, Dept Radiol, Boston, MA 02114 USA
dc.description.affiliation Boston Univ, Boston Med Ctr, Dept Neurol, Boston, MA 02215 USA
dc.description.affiliation Massachusetts Gen Hosp, Dept Neurol, Stroke Serv, Boston, MA 02114 USA
dc.description.affiliation NINDS, Bethesda, MD 20892 USA
dc.description.affiliation Univ Calif San Francisco, Dept Neurol, Neurovasc Serv, San Francisco, CA USA
dc.description.affiliation Emory Univ, Grady Mem Hosp, Sch Med, Neuroendovasc & Neurocrit Care Serv,Marcus Stroke, Atlanta, GA USA
dc.description.affiliationUnifesp Universidade Federal de São Paulo, Dept Neurol, Neurovasc Serv, São Paulo, Brazil
dc.description.sponsorshipID US Department of Health and Human Services/Agency for Healthcare Research and Quality: RO1-HS011392-O1A1
dc.identifier.doi 10.1001/jamaneurol.2013.5007
dc.description.source Web of Science
dc.identifier.wos WOS:000332830300004



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