The 2-Year Outcomes Comparison between Ischemic Stroke Patients with Intracranial Arterial Stenosis without Significant Extracranial Carotid Stenosis and Patients with Extracranial Carotid Stenosis
Kulthida Methawasin MD, MSc*, Nijasri C. Suwanwela MD**, Kammant Phanthumchinda MD**
Affiliation : * Division of Neurology, Department of Medicine, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand, ** Division of Neurology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
Objective : The risk of recurrent ischemic stroke and acute coronary syndrome increased in the large artery atherosclerotic
subtype. The purpose of this study was to compare 2-year outcomes between the ischemic stroke patients with intracranial
arterial stenosis without significant extracranial carotid stenosis and the patients with extracranial carotid stenosis.
Material and Method: This study prospectively compared 123 ischemic stroke patients: 71 patients with intracranial arterial
stenosis without significant extracranial carotid stenosis and 52 patients with extracranial carotid stenosis. Neurologic and
radiologic investigations were performed at the beginning of the study. All of them were treated as regular outpatients of the
neurology unit with a mean follow-up of 24 months. Recurrent stroke, myocardial infarction, and death were recorded.
Results : Fifteen patients of the extracranial carotid stenosis group and eighteen patients of the intracranial arterial stenosis
without significant extracranial carotid stenosis group developed recurrent stroke during follow-up (p = 0.40). Acute
coronary syndrome occurred in eight patients of the extracranial carotid stenosis group and only one of the intracranial
arterial stenosis without significant extracranial carotid stenosis group (p = 0.004). Causes of death were end stage cancers,
stroke and related conditions, and acute coronary syndrome. The multivariate analysis showed that symptomatic extracranial
carotid stenosis is an important risk factor of the acute coronary syndrome (p = 0.03, OR = 10.81, 95% CI 1.23-94.77).
Conclusion : There was no significant difference of recurrent ischemic stroke and recurrent stroke between patients with
intracranial arterial stenosis without extracranial carotid stenosis and patients with extracranial carotid stenosis. On the
other hand, patients with extracranial carotid stenosis had more incidences of acute coronary syndrome significantly than
patients with intracranial arterial stenosis.
Keywords : Ischemic stroke, Intracranial arterial stenosis, Extracranial carotid stenosis, Stroke outcomes
