Clinical course and prognosis of internal carotid artery occlusion in the acute stage

Patients with ischemic cerebrovascular disease take such varied clinical courses that it has long been difficult to predict, especially in the acute stages, the prognosis precisely and to evaluate the effectiveness of any kind of treatment. Recent development in drugs with protective effects on the ischemic brain and in surgical methods for revascularization under the administration of such substances have necessitated the analysis of the socalled “natural course” of this type of stroke. In this study, the clinical courses of 104 patients with internal carotid artery occlusion, confirmed by cerebral angiography, were prospectively analyzed. They were selected from 1000 cases with ischemic cerebrovasuclar disease collected in a cooperative study which was organized at the Eighth Annual Meeting of the Japan Stroke Society in 1983. Patients were all admitted within 24 hours from onset and were evaluated sequentially for two months, treated neither by surgery nor with such special therapeutics as barbiturates. The level of consciousness and motor function were graded using the “III-3 formula” and DeJong's criteria, respectively. Prognosis at the second month was evaluated in five grades. Of the 104 patients, the prognosis was excellent in 5 (4.8%), good in 6 (5.8%), fair in 11 (10.6%), poor in 31 (29.8%), and 51 patients died (49.0%). The prognosis of patients over the age of 60 was worse than that of those under 60. The site of occlusion, extra- or intracranial, had no significant relation with the prognosis. Among the 104 patients, 30 had thrombosis and 55 had embolism' the prognosis of the latter being significantly worse than that of the former. The lower the level of consciousness on admission, the worse the prognosis. Among the patients in a grade II or III state of consciousness, about 75% died. It was also found that the lower the grade of motor function on admission, the worse the prognosis. Among the patients with a grade 2 motor function or worse, almost none of the patients returned to social life. According to the size of low density areas (LDAs) in CT scans, patients were divided into four groups. The larger the size of LDA, the worse the prognosis. When the LDA covered the whole territory fed by the middle cerebral artery, no patients returned to social life. Among those in whom the LDA extended over the area fed by two or more main trunks, 90% died. Hemorrhagic infarction was detected in the CT scans of 19 patients, but the prognosis was unaffe