BACKGROUNDIncidence and natural history of acute bihemispheric strokes (ABS) are poorly known. Aim of our study was to identify frequency, associated factors, and outcome of a consecutive series of ...ABS patients from a single carotid source, focusing on the Willis' polygon morphology.METHODSIn the ASTRAL registry (2003-u00adu201018), we retrospectively reviewed data from anterior ABS patients affected by carotid atherosclerosis or dissection on DWI-MRI. Overall Willis' patency or incompleteness (i.e. absence/hypoplasic A1, P1, anterior/posterior communicating arteries) was recorded. Patients with bihemispheric lesions were compared with patients with unilateral lesion in a matched 1:3 analysis for age, grade of stenosis and TOAST. A multivariate analysis was performed to identify independent factors associated with ABS.RESULTSOut of 186 patients with single carotid source (16% dissections), we identified 24 (13%) ABS patients. In the univariate analysis on the matched cohort, patients with ABS had lower diastolic blood pressure on admission(73 vs. 87 mmHg, p=0.007), more frequently contralateral internal carotid (ICA) occlusion (p=0.046) and absence of anterior communicating artery (ACoA) (70% vs. 25 %, p<0.001). On multivariate analysis, contralateral ICA occlusion and absence of ACoA were independent predictors of ABS (OR=15.64; 95%CI:2.09-u00ad 117.25 and OR=9.19; 95%CI:2.86-u00adu201025.00, respectively). ABS was associated tohigher recurrence rate (18.2 vs 4.5%, p=0.060) and worse 3u2010month outcome (median mRS 3 vs 1, p=0.012).CONCLUSIONSOcclusion of contralateral ICA and absence of ACoA were predictors of bilateral ischemic lesions in stroke due to single carotid artery source. These findings suggest an important role of hemodynamic mechanisms in the pathogenesis of ABS.
IntroductionArterial recanalization and early reocclusion after successful recanalization are strong determinants of prognosis in acute ischemic stroke. We assessed associated factors and long-term ...prognosis of reocclusion after successful mechanical thrombectomy (MT).MethodsPatients from the Acute STroke Registry and Analysis of Lausanne (ASTRAL), from January 2003 to August 2018, treated by successful MT (mTICI 2b-3) and with a 24-hour vascular imaging (computed tomographic or magnetic resonance angiography; window 12-48hours) were included. Reocclusion at this time-point was defined as a new intracranial occlusion within an arterial segment recanalized at the end of MT. Multivariate logistic regression was used to investigate factors associated with reocclusion and its long-term clinical impact. In a 4:1 matched-cohort analysis, presence of residual thrombus/stenosis on final angiographic run post-MT was included as a variable in a second logistic regression for factors associated with reocclusion.ResultsAmong 423 patients with successful recanalization, 28 (6.6%) showed 24-hour reocclusion. Factors independently associated with reocclusion in entire and matched cohorts are displayed in the table below. Residual thrombus/stenosis finding had a positive predictor value for reocclusion of 46.5% (95%CI 36.06%u201357.28%). 24-hour reocclusion was highly associated with unfavourable outcome (adjusted-OR for modified Rankin Scale >2, 5.0; 95%CI 1.2u201320.0). ConclusionAfter successful MT, arterial reocclusion within 24-hours was independently associated with occlusion site, atherosclerotic mechanism, procedural difficulties, and residual thrombus or stenosis on the final angiographic run. Preadmission statin therapy seemed protective. Reocclusion had a major impact on long-term outcome highlighting the need to improve strategies to monitor and prevent it.
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