Abstract
Objectives
Paradoxical intracranial hemodynamic steal (IHS) is known in patients having persistent
proximal arterial occlusions and is linked with early neurological worsening. However,
stroke risk specific to symptomatic internal carotid artery occlusions (SICAO) having
paradoxical IHS is unknown. Therefore, we aimed to investigate the association of
paradoxical IHS in SICAO patients with stroke recurrence during a one-year follow-up.
Materials and methods
We prospectively enrolled adult patients having SICAO with a recent history of ischemic
events. Steal magnitude (SM) to classify patients in IHS and non-IHS categories was
evaluated by a breath-holding test using bilateral transcranial doppler (TCD). Patients
were prescribed optimal medical therapy and followed up for one year for any ischemic
stroke/TIA/cardiovascular death.
Results
36 SICAO patients, mean age of 56 years, were assessed using TCD at median 22.5 days
(Interquartile range, IQR= 9-42), and 11 (30.6%) had paradoxical IHS with median SM
12% (IQR= 6%-18%). On follow-up, 7 (19.4%) patients had event recurrence and its association
with IHS was non-significant (IHS vs non-IHS, 18.2% vs 20%; Log-rank statistics=0.006;
P=0.940). On Cox regression analysis, event recurrence was independently associated
with the presence of significant contralateral stenosis only (regression coefficient=
2.237; P= 0.012; 95% CI= 1.63-53.89).
Conclusions
IHS prevalence among SICAO is high. However, paradoxical IHS was not associated with
an increased risk of stroke in SICAO. Therefore, the presence of paradoxical IHS in
SICAO may be considered a transit state and does not necessarily imply an increased
risk of stroke.
Key Words
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Article info
Publication history
Published online: December 16, 2022
Accepted:
September 18,
2022
Received:
August 17,
2022
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2022.106797
Copyright
© 2022 Published by Elsevier Inc.
