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

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. [ABSTRACT FROM AUTHOR]