Risk Factors For Symptomatic Carotid Occlusion
Matthew Vuoncino, M.D., Gregory Brittenham, DO, Bryan Kuo, William J. Yoon, Nasim Hedayati, MD.
UC Davis, Sacramento, CA, USA.
Objectives: Extracranial carotid artery disease is among one of the most common causes of stroke. Both internal carotid artery (ICA) stenosis and ICA occlusion are risk factors for ipsilateral stroke. In select patient populations, intervention for ICA stenosis can reduce stroke risk; however, carotid occlusion does not benefit from intervention. The purpose of this study is to define risk factors for symptomatic ICA occlusion. Additionally, our aim was to determine if pre-existing carotid artery disease led to an increased rate of symptomatic occlusion. Methods: 296 patients were retrospectively identified with ICA occlusion shown on duplex ultrasound or CT scan between January 2010 and December 2020 at University of California-Davis Medical Center. Patients were included in the analysis only if there was a prior study showing patency of the ICA prior to documented occlusion. Patients were grouped into the symptomatic group and the asymptomatic group based on presentation at time of ICA occlusion. Fisher Exact test was used to determine risk factors for ipsilateral neurological events at the time of occlusion. Results: 620 imaging studies were evaluated over the ten-year period, showing ICA occlusion in 296 patients. A total of 39 patients had imaging prior to ICA occlusion demonstrating patent ipsilateral ICA. 12 patients (31%) had stroke-like symptoms attributable to ipsilateral ICA occlusion. The average age at time of occlusion was 70 years old, and 25 patients were male (64%), there was no significant difference between the symptomatic and asymptomatic group. There was no difference between statin and anti-platelet use between the symptomatic and asymptomatic patients. Pre-existing ICA stenosis was not associated with an increased rate of symptomatic occlusion (p=0.06). Conclusion: Our data suggests pre-existing carotid disease is not associated with symptomatic carotid occlusion. Carotid occlusion is a rarely tracked occurrence, thus our single institution study had a paucity of patients with imaging prior to occlusion. Further exploration of risk factors associated with carotid occlusion may benefit from multi-center collaboration.
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