Frequency and outcome of total anterior circulation strokes without intracranial large-vessel occlusion

Eur J Neurol. 2017 Jan;24(1):11-17. doi: 10.1111/ene.13187. Epub 2016 Nov 10.


Background and purpose: The percentage of patients with clinical total anterior circulation infarct (TACI) syndrome treated with reperfusion therapies in the absence of intracranial large-vessel occlusion (ILVO) was determined and their characteristics and outcome are described.

Methods: Data from a population-based, prospective, externally audited registry of all stroke patients treated with intravenous thrombolysis (IVT) and endovascular therapies in Catalonia from January 2011 to December 2013 were used. Patients with a baseline TACI and initial stroke severity measured by the National Institute of Health Stroke Scale (NIHSS) ≥ 8, evaluated less than 4.5 h post-onset, for whom a vascular study prior to treatment was available (n = 1070) were selected. Clinical characteristics, outcome and radiological data for patients treated with IVT alone (n = 605) were compared between those with detected ILVO (n = 474) and non-ILVO patients (n = 131).

Results: A total of 1070 patients met study criteria; non-ILVO was found in 131 (12.2%). Analysing the 605 patients treated only with IVT, no significant differences were found between non-ILVO and ILVO patients in age, sex, risk factors, time-to-treatment and type of radiological studies performed. Although non-ILVO patients had lower initial stroke severity (P < 0.001) and a better prognosis (P = 0.001), 51.3% had a poor outcome and 16% were deceased at 90 days. In 66.4% of patients without ILVO, a recent anterior territorial infarct was detected.

Conclusions: Intracranial artery patency was observed in 12.2% of TACI patients evaluated within 4.5 h. Although absence of ILVO was associated with slightly better prognosis, more than half had a poor outcome at 3 months.

Keywords: intravenous thrombolysis; ischaemic stroke; prognosis.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Arterial Occlusive Diseases / diagnostic imaging
  • Arterial Occlusive Diseases / epidemiology*
  • Arterial Occlusive Diseases / pathology*
  • Cerebral Arteries / pathology
  • Endovascular Procedures
  • Female
  • Humans
  • Infarction, Anterior Cerebral Artery / diagnostic imaging
  • Infarction, Anterior Cerebral Artery / epidemiology*
  • Infarction, Anterior Cerebral Artery / pathology*
  • Male
  • Middle Aged
  • Prognosis
  • Prospective Studies
  • Registries
  • Risk Factors
  • Spain / epidemiology
  • Stroke / epidemiology*
  • Stroke / pathology*
  • Stroke / therapy
  • Thrombolytic Therapy
  • Treatment Outcome