Clinical and laboratory characteristics of moderate and severe cerebral ischemic stroke without significant carotid artery thrombosis

BACKGROUND: Due to its high prevalence and severe disability outcomes, ischemic stroke remains one of the major challenges in modern neurology, requiring detailed investigation aimed at developing more effective therapeutic and preventive strategies. It is generally believed that more severe cases of stroke are associated with thrombosis or occlusion of major intracranial arteries; consequently, most published studies have focused on the rapid removal of the thrombus. Patients with severe stroke without thrombosis of cerebral arteries confirmed by CT angiography (NIHSS score >6) receive treatment according to current clinical practice guidelines; however, dedicated diagnostic pathways for verifying the cause of stroke and approaches to secondary prevention in this subgroup have not yet been fully defined.

AIM: This study aimed to investigate clinical, radiological, and laboratory characteristics in patients with ischemic stroke according to the presence or absence of carotid artery thrombosis as detected by CT angiography performed in the emergency department.

METHODS: The study included 194 patients with confirmed moderate or severe ischemic stroke treated at a regional vascular center between 2021 and 2023. A comparative analysis was performed between two groups of patients stratified according to the presence (comparison group, n = 98) or absence (main group, n = 96) of large cerebral artery thrombosis as detected by CT angiography during the acute phase of ischemic stroke.

RESULTS: Patients with ischemic stroke without evidence of obstructive carotid artery thrombosis on CT angiography were older (68.6 ± 10.5 years) than those with thrombosis (64.9 ± 10.8 years; p = 0.04). Statistically significant sex-related differences were observed (p < 0.001). Among the 96 patients in the main group, 61.6% (n = 59) were women and 38.4% (n = 37) were men, whereas in the comparison group, 37.7% (n = 37) were women and 62.3% (n = 61) were men. Cryptogenic stroke was significantly more common in the main group (p < 0.001), whereas atherothrombotic stroke predominated in the comparison group. Echocardiography in patients of the main group more frequently revealed left atrial enlargement and/or areas of fibrosis and hypokinesia (p < 0.01) compared with the comparison group; these findings are recognized predictors of atrial fibrillation.

CONCLUSION: The prognosis during the acute phase of ischemic stroke in patients without carotid artery thrombosis verified by CT angiography is more favorable than in those with thrombosis. The findings suggest that patients with moderate and severe ischemic stroke in the carotid territory without detectable arterial thrombosis require long-term follow-up to assess the incidence of recurrent stroke, as well as extended (≥ 72-hour) Holter monitoring, which may improve the detection of cardiac rhythm disturbances.