Ipsilateral and contralateral carotid stenosis contribute to the outcome of reperfusion treatment for ischemic stroke

Giovanna Viticchi; Lorenzo Falsetti; Alice Riva; Silvia Paolucci; Simone Malatini; Emanuele Guerrieri; Marco Bartolini; Mauro Silvestrini

doi:10.3389/fneur.2023.1237721

Ipsilateral and contralateral carotid stenosis contribute to the outcome of reperfusion treatment for ischemic stroke

Front Neurol. 2023 Aug 10:14:1237721. doi: 10.3389/fneur.2023.1237721. eCollection 2023.

Authors

Giovanna Viticchi¹, Lorenzo Falsetti², Alice Riva¹, Silvia Paolucci¹, Simone Malatini¹, Emanuele Guerrieri³, Marco Bartolini¹, Mauro Silvestrini¹

Affiliations

¹ Neurological Clinic, Marche Polytechnic University, Ancona, Italy.
² Internal and Subintensive Medicine, Azienda Ospedaliero-Universitaria delle Marche, Ancona, Italy.
³ Emergency Medicine Residency Program, Marche Polytechnic University, Ancona, Italy.

Abstract

Introduction: Ipsilateral and contralateral carotid stenosis (ICS, CCS) influence acute ischemic stroke (AIS) severity and prognosis. Few data are available about their impact on reperfusion therapies efficacy. Aim of this study was to evaluate the impact of ICS and CCS on the effect of intravenous thrombolysis (IT), mechanical thrombectomy (MT) or both and of antiplatelet therapy (AT).

Methods: We enrolled all the consecutive patients admitted for AIS to our stroke unit and submitted to IT, MT, IT+MT, or AT. We established the presence of a significant ICS or CCS (≥70%) by ultrasound examination or brain angio-CT, or MRI. Clinical and instrumental information were collected; delta National Institutes of Health Stroke Scale (NIHSS) from pre-treatment to patients' discharge was employed as the main outcome measure.

Results: In total, 460 subjects were enrolled, 86 with ICS and 38 with CCS. We observed a significant linear trend of delta (NIHSS) between carotid stenosis categories for patients undergoing IT (p = 0.011), MT (p = 0.046), and MT+IT (p = 0.040), but no significant trend among subjects receiving no reperfusion treatments was observed (p = 0.174).

Discussion: According to our findings, ICS and CCS negatively influence AIS patients' outcome treated by interventional therapies. ICS might exert an unfavorable effect both by cerebral hypoperfusion and by continuous microembolization toward ischemic area, while CCS is probable involved in reducing the collateral circles effectiveness. The importance of early carotid stenosis detection and treatment should then be reevaluated not only to manage the prevention approaches but also to obtain insights about post-stroke treatment strategies efficacy.

Keywords: carotid ultrasound; contralateral carotid stenosis; ipsilateral carotid stenosis; ischemic stroke; reperfusion treatment.