Abstract
Anterior circulation large artery occlusion (AC-LAO) related acute ischemic stroke (AIS) is particularly common in clinics in China. We retrospectively analyzed 787 consecutively hospitalized AIS patients with AC-LAO in Hebei Province, China. AC-LAO was defined as a complete occlusion of at least one intracranial internal carotid artery (ICA) or middle cerebral artery (MCA) based on computed tomography or magnetic resonance angiography. Among eight subtypes of AC-LAO, unilateral MCA occlusion is the most common one (49.8%, n = 392), while bilateral ICA/unilateral MCA occlusion is the least (0.3%, n = 2). Compared with unilateral MCA and unilateral ICA occlusion, patients with tandem ICA/MCA and bilateral ICA/MCA occlusion had poor outcomes after suffering AIS. Age (OR 1.022; 95%CI, 1.007 to 1.036) was an independent risk factor for single artery progressed to multiple artery occlusion, while ApoA1 (OR 0.453; 95% CI, 0.235 to 0.953) was a protective factor. Patients with unilateral MCA occlusion were prone to artery-to-artery embolism infarction subtype, unilateral ICA occlusion group were the most vulnerable to hypoperfusion/impaired emboli clearance subtype. Our results suggested various AC-LAO subtypes have different clinical characteristics and prognosis and were prone to different subtypes of infarction. Customized preventive measures based on AC-LAO subtypes may be more targeted preventions of stroke recurrences for AIS patients and could improve their prognoses.
Highlights
Anterior circulation large artery occlusion (AC-LAO) related acute ischemic stroke (AIS) is common in clinics in China
AC-LAO was defined as the presence of complete occlusion of at least one unilateral intracranial internal carotid artery (ICA) or middle cerebral artery (MCA) based on CTA or MRA, and the criterion of AIS was new cerebral infarction confirmed with CT and/or DWI results[11]
Since only two patients were in the bilateral ICA/unilateral MCA group, this group was excluded for statistical analysis
Summary
Anterior circulation large artery occlusion (AC-LAO) related acute ischemic stroke (AIS) is common in clinics in China. Previous study showed intravenous thrombolysis and endovascular intervention treatments may not be effective in most patients with high clot burden LAO, and the resulting emboli may cause a worse prognosis[7]. We found that most studies focusing on single unilateral middle cerebral artery (MCA), unilateral internal carotid artery (ICA), or tandem ICA/MCA occlusion, showing that a thrombus in the more proximal intracranial vasculature were more likely to have a poor outcome[8,9,10]. Our aim of this study was to investigate the clinical characteristics of different subtypes of AC-LAO with acute brain ischemic stroke, and to further analyze the risk factors and prognosis of different subtypes of AC-LAO related with AIS
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