Functional Aplasia of the Contralateral A1 Segment Influences Clinical Outcome in Patients with Occlusion of the Distal Internal Carotid Artery
Background: The importance of an A1 aplasia remains unclear in stroke patients. In this work, we analyze the impact of an A1 aplasia contralateral to an acute occlusion of the distal internal carotid artery (ICA) on clinical outcomes. Methods: We conducted a retrospective study of consecutive stroke...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2022-02-01
|
| Series: | Journal of Clinical Medicine |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2077-0383/11/5/1293 |
| _version_ | 1797474704316956672 |
|---|---|
| author | Sebastian Fischer Lukas Goertz Charlotte S. Weyland Ali Khanafer Christoph J. Maurer Hanna Zimmermann Thomas David Fischer Hanna Styczen Benjamin Tan Maria Alexandrou Donald Lobsien Elmar Lobsien Maximilian Thormann Lukas Meyer Nuran Abdullayev Jens Fiehler Anastasios Mpotsaris Panagiotis Papanagiotou Leonard Yeo Cornelius Deuschl Thomas Liebig Ansgar Berlis Hans Henkes Markus Möhlenbruch Volker Maus |
| author_facet | Sebastian Fischer Lukas Goertz Charlotte S. Weyland Ali Khanafer Christoph J. Maurer Hanna Zimmermann Thomas David Fischer Hanna Styczen Benjamin Tan Maria Alexandrou Donald Lobsien Elmar Lobsien Maximilian Thormann Lukas Meyer Nuran Abdullayev Jens Fiehler Anastasios Mpotsaris Panagiotis Papanagiotou Leonard Yeo Cornelius Deuschl Thomas Liebig Ansgar Berlis Hans Henkes Markus Möhlenbruch Volker Maus |
| author_sort | Sebastian Fischer |
| collection | DOAJ |
| description | Background: The importance of an A1 aplasia remains unclear in stroke patients. In this work, we analyze the impact of an A1 aplasia contralateral to an acute occlusion of the distal internal carotid artery (ICA) on clinical outcomes. Methods: We conducted a retrospective study of consecutive stroke patients treated with mechanical thrombectomy at 12 tertiary care centers between January 2015 and February 2021 due to an occlusion of the distal ICA. Functional A1 aplasia was defined as the absence of A1 or hypoplastic A1 (>50% reduction to the contralateral site). Functional independence was measured by the modified Rankin Scale (mRS ≤ 2). Results: In total, 81 out of 1068 (8%) patients had functional A1 aplasia contralateral to distal ICA occlusion. Patients with functional contralateral A1 aplasia were more severely affected on admission (median NIHSS 18, IQR 15–23 vs. 17, IQR 13–21; aOR: 0.672, 95% CI: 0.448–1.007, <i>p</i> = 0.054) and post-interventional ischemic damage was larger (median ASPECTS 5, IQR 1–7, vs. 6, IQR 3–8; aOR: 1.817, 95% CI: 1.184–2.789, <i>p</i> = 0.006). Infarction occurred more often within the ipsilateral ACA territory (20/76, 26% vs. 110/961, 11%; aOR: 2.482, 95% CI: 1.389–4.437, <i>p</i> = 0.002) and both ACA territories (8/76, 11% vs. 5/961, 1%; aOR: 17.968, 95% CI: 4.979–64.847, <i>p</i> ≤ 0.001). Functional contralateral A1 aplasia was associated with a lower rate of functional independence at discharge (6/81, 8% vs. 194/965, 20%; aOR: 2.579, 95% CI: 1.086–6.122, <i>p</i> = 0.032) and after 90 days (5/55, 9% vs. 170/723, 24%; aOR: 2.664, 95% CI: 1.031–6.883, <i>p</i> = 0.043). Conclusions: A functional A1 aplasia contralateral to a distal ICA occlusion is associated with a poorer clinical outcome. |
| first_indexed | 2024-03-09T20:34:55Z |
| format | Article |
| id | doaj.art-59e45485fbe84d338b8352d175d2caab |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-09T20:34:55Z |
| publishDate | 2022-02-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-59e45485fbe84d338b8352d175d2caab2023-11-23T23:13:42ZengMDPI AGJournal of Clinical Medicine2077-03832022-02-01115129310.3390/jcm11051293Functional Aplasia of the Contralateral A1 Segment Influences Clinical Outcome in Patients with Occlusion of the Distal Internal Carotid ArterySebastian Fischer0Lukas Goertz1Charlotte S. Weyland2Ali Khanafer3Christoph J. Maurer4Hanna Zimmermann5Thomas David Fischer6Hanna Styczen7Benjamin Tan8Maria Alexandrou9Donald Lobsien10Elmar Lobsien11Maximilian Thormann12Lukas Meyer13Nuran Abdullayev14Jens Fiehler15Anastasios Mpotsaris16Panagiotis Papanagiotou17Leonard Yeo18Cornelius Deuschl19Thomas Liebig20Ansgar Berlis21Hans Henkes22Markus Möhlenbruch23Volker Maus24Institute of Diagnostic and Interventional Radiology, Neuroradiology and Nuclear Medicine, Knappschaftskrankenhaus Bochum, Ruhr-University Bochum, 44892 Bochum, GermanyDepartment of Diagnostic and Interventional Radiology, University Hospital Cologne, 50937 Cologne, GermanyDepartment of Diagnostic and Interventional Neuroradiology, University Hospital Heidelberg, 69120 Heidelberg, GermanyNeuroradiological Clinic, Klinikum Stuttgart, 70174 Stuttgart, GermanyDepartment of Diagnostic and Interventional Neuroradiology, University Hospital Augsburg, 86156 Augsburg, GermanyInstitute for Diagnostic and Interventional Neuroradiology, University Hospital München-Großhadern, 81377 Munich, GermanyInstitute for Diagnostic and Interventional Neuroradiology, University Hospital München-Großhadern, 81377 Munich, GermanyInstitute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, 45147 Essen, GermanyDivision of Neurology, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore 119077, SingaporeDepartment of Diagnostic and Interventional Neuroradiology, Klinikum Bremen-Mitte, 28211 Bremen, GermanyDepartment of Diagnostic and Interventional Radiology and Neuroradiology, Helios General Hospital Erfurt, 99089 Erfurt, GermanyDepartment of Neurology, Helios General Hospital Erfurt, 99089 Erfurt, GermanyDepartment of Diagnostic and Interventional Radiology, University Hospital Magdeburg, 39120 Magdeburg, GermanyDepartment of Diagnostic and Interventional Neuroradiology, University Hospital Hamburg-Eppendorf, 20246 Hamburg, GermanyDepartment of Diagnostic and Interventional Radiology, University Hospital Cologne, 50937 Cologne, GermanyDepartment of Diagnostic and Interventional Neuroradiology, University Hospital Hamburg-Eppendorf, 20246 Hamburg, GermanyDepartment of Diagnostic and Interventional Radiology, University Hospital Magdeburg, 39120 Magdeburg, GermanyDepartment of Diagnostic and Interventional Neuroradiology, Klinikum Bremen-Mitte, 28211 Bremen, GermanyDivision of Neurology, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore 119077, SingaporeInstitute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, 45147 Essen, GermanyInstitute for Diagnostic and Interventional Neuroradiology, University Hospital München-Großhadern, 81377 Munich, GermanyDepartment of Diagnostic and Interventional Neuroradiology, University Hospital Augsburg, 86156 Augsburg, GermanyNeuroradiological Clinic, Klinikum Stuttgart, 70174 Stuttgart, GermanyDepartment of Diagnostic and Interventional Neuroradiology, University Hospital Heidelberg, 69120 Heidelberg, GermanyInstitute of Diagnostic and Interventional Radiology, Neuroradiology and Nuclear Medicine, Knappschaftskrankenhaus Bochum, Ruhr-University Bochum, 44892 Bochum, GermanyBackground: The importance of an A1 aplasia remains unclear in stroke patients. In this work, we analyze the impact of an A1 aplasia contralateral to an acute occlusion of the distal internal carotid artery (ICA) on clinical outcomes. Methods: We conducted a retrospective study of consecutive stroke patients treated with mechanical thrombectomy at 12 tertiary care centers between January 2015 and February 2021 due to an occlusion of the distal ICA. Functional A1 aplasia was defined as the absence of A1 or hypoplastic A1 (>50% reduction to the contralateral site). Functional independence was measured by the modified Rankin Scale (mRS ≤ 2). Results: In total, 81 out of 1068 (8%) patients had functional A1 aplasia contralateral to distal ICA occlusion. Patients with functional contralateral A1 aplasia were more severely affected on admission (median NIHSS 18, IQR 15–23 vs. 17, IQR 13–21; aOR: 0.672, 95% CI: 0.448–1.007, <i>p</i> = 0.054) and post-interventional ischemic damage was larger (median ASPECTS 5, IQR 1–7, vs. 6, IQR 3–8; aOR: 1.817, 95% CI: 1.184–2.789, <i>p</i> = 0.006). Infarction occurred more often within the ipsilateral ACA territory (20/76, 26% vs. 110/961, 11%; aOR: 2.482, 95% CI: 1.389–4.437, <i>p</i> = 0.002) and both ACA territories (8/76, 11% vs. 5/961, 1%; aOR: 17.968, 95% CI: 4.979–64.847, <i>p</i> ≤ 0.001). Functional contralateral A1 aplasia was associated with a lower rate of functional independence at discharge (6/81, 8% vs. 194/965, 20%; aOR: 2.579, 95% CI: 1.086–6.122, <i>p</i> = 0.032) and after 90 days (5/55, 9% vs. 170/723, 24%; aOR: 2.664, 95% CI: 1.031–6.883, <i>p</i> = 0.043). Conclusions: A functional A1 aplasia contralateral to a distal ICA occlusion is associated with a poorer clinical outcome.https://www.mdpi.com/2077-0383/11/5/1293mechanical thrombectomyacute ischemic strokeICA occlusion |
| spellingShingle | Sebastian Fischer Lukas Goertz Charlotte S. Weyland Ali Khanafer Christoph J. Maurer Hanna Zimmermann Thomas David Fischer Hanna Styczen Benjamin Tan Maria Alexandrou Donald Lobsien Elmar Lobsien Maximilian Thormann Lukas Meyer Nuran Abdullayev Jens Fiehler Anastasios Mpotsaris Panagiotis Papanagiotou Leonard Yeo Cornelius Deuschl Thomas Liebig Ansgar Berlis Hans Henkes Markus Möhlenbruch Volker Maus Functional Aplasia of the Contralateral A1 Segment Influences Clinical Outcome in Patients with Occlusion of the Distal Internal Carotid Artery Journal of Clinical Medicine mechanical thrombectomy acute ischemic stroke ICA occlusion |
| title | Functional Aplasia of the Contralateral A1 Segment Influences Clinical Outcome in Patients with Occlusion of the Distal Internal Carotid Artery |
| title_full | Functional Aplasia of the Contralateral A1 Segment Influences Clinical Outcome in Patients with Occlusion of the Distal Internal Carotid Artery |
| title_fullStr | Functional Aplasia of the Contralateral A1 Segment Influences Clinical Outcome in Patients with Occlusion of the Distal Internal Carotid Artery |
| title_full_unstemmed | Functional Aplasia of the Contralateral A1 Segment Influences Clinical Outcome in Patients with Occlusion of the Distal Internal Carotid Artery |
| title_short | Functional Aplasia of the Contralateral A1 Segment Influences Clinical Outcome in Patients with Occlusion of the Distal Internal Carotid Artery |
| title_sort | functional aplasia of the contralateral a1 segment influences clinical outcome in patients with occlusion of the distal internal carotid artery |
| topic | mechanical thrombectomy acute ischemic stroke ICA occlusion |
| url | https://www.mdpi.com/2077-0383/11/5/1293 |
| work_keys_str_mv | AT sebastianfischer functionalaplasiaofthecontralaterala1segmentinfluencesclinicaloutcomeinpatientswithocclusionofthedistalinternalcarotidartery AT lukasgoertz functionalaplasiaofthecontralaterala1segmentinfluencesclinicaloutcomeinpatientswithocclusionofthedistalinternalcarotidartery AT charlottesweyland functionalaplasiaofthecontralaterala1segmentinfluencesclinicaloutcomeinpatientswithocclusionofthedistalinternalcarotidartery AT alikhanafer functionalaplasiaofthecontralaterala1segmentinfluencesclinicaloutcomeinpatientswithocclusionofthedistalinternalcarotidartery AT christophjmaurer functionalaplasiaofthecontralaterala1segmentinfluencesclinicaloutcomeinpatientswithocclusionofthedistalinternalcarotidartery AT hannazimmermann functionalaplasiaofthecontralaterala1segmentinfluencesclinicaloutcomeinpatientswithocclusionofthedistalinternalcarotidartery AT thomasdavidfischer functionalaplasiaofthecontralaterala1segmentinfluencesclinicaloutcomeinpatientswithocclusionofthedistalinternalcarotidartery AT hannastyczen functionalaplasiaofthecontralaterala1segmentinfluencesclinicaloutcomeinpatientswithocclusionofthedistalinternalcarotidartery AT benjamintan functionalaplasiaofthecontralaterala1segmentinfluencesclinicaloutcomeinpatientswithocclusionofthedistalinternalcarotidartery AT mariaalexandrou functionalaplasiaofthecontralaterala1segmentinfluencesclinicaloutcomeinpatientswithocclusionofthedistalinternalcarotidartery AT donaldlobsien functionalaplasiaofthecontralaterala1segmentinfluencesclinicaloutcomeinpatientswithocclusionofthedistalinternalcarotidartery AT elmarlobsien functionalaplasiaofthecontralaterala1segmentinfluencesclinicaloutcomeinpatientswithocclusionofthedistalinternalcarotidartery AT maximilianthormann functionalaplasiaofthecontralaterala1segmentinfluencesclinicaloutcomeinpatientswithocclusionofthedistalinternalcarotidartery AT lukasmeyer functionalaplasiaofthecontralaterala1segmentinfluencesclinicaloutcomeinpatientswithocclusionofthedistalinternalcarotidartery AT nuranabdullayev functionalaplasiaofthecontralaterala1segmentinfluencesclinicaloutcomeinpatientswithocclusionofthedistalinternalcarotidartery AT jensfiehler functionalaplasiaofthecontralaterala1segmentinfluencesclinicaloutcomeinpatientswithocclusionofthedistalinternalcarotidartery AT anastasiosmpotsaris functionalaplasiaofthecontralaterala1segmentinfluencesclinicaloutcomeinpatientswithocclusionofthedistalinternalcarotidartery AT panagiotispapanagiotou functionalaplasiaofthecontralaterala1segmentinfluencesclinicaloutcomeinpatientswithocclusionofthedistalinternalcarotidartery AT leonardyeo functionalaplasiaofthecontralaterala1segmentinfluencesclinicaloutcomeinpatientswithocclusionofthedistalinternalcarotidartery AT corneliusdeuschl functionalaplasiaofthecontralaterala1segmentinfluencesclinicaloutcomeinpatientswithocclusionofthedistalinternalcarotidartery AT thomasliebig functionalaplasiaofthecontralaterala1segmentinfluencesclinicaloutcomeinpatientswithocclusionofthedistalinternalcarotidartery AT ansgarberlis functionalaplasiaofthecontralaterala1segmentinfluencesclinicaloutcomeinpatientswithocclusionofthedistalinternalcarotidartery AT hanshenkes functionalaplasiaofthecontralaterala1segmentinfluencesclinicaloutcomeinpatientswithocclusionofthedistalinternalcarotidartery AT markusmohlenbruch functionalaplasiaofthecontralaterala1segmentinfluencesclinicaloutcomeinpatientswithocclusionofthedistalinternalcarotidartery AT volkermaus functionalaplasiaofthecontralaterala1segmentinfluencesclinicaloutcomeinpatientswithocclusionofthedistalinternalcarotidartery |