Published Online
on July 1, 2004

A more recent version of this article appeared on August 1, 2004

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Submitted on March 4, 2004
Revised on April 29, 2004
Accepted on May 14, 2004

Population-Based Study of Symptomatic Internal Carotid Artery Occlusion. Incidence and Long-Term Follow-Up

Matthew L. Flaherty MD; Kelly D. Flemming MD; Robyn McClelland PhD; Neal W. Jorgensen BS; and Robert D. Brown Jr MD, MPH^*

From the Departments of Neurology (M.L.F., K.D.F., R.D.B.) and Health Sciences Research (R.M., N.W.J.), Mayo Clinic College of Medicine, Rochester, Minn. M.L.F. is currently affiliated with the Department of Neurology, University of Cincinnati, Ohio.

^* To whom correspondence should be addressed. E-mail: Brown.robert{at}mayo.edu.

Background and Purpose--Internal carotid artery (ICA) occlusion is an important cause of transient ischemic attack (TIA) and cerebral infarction. There are no previous population-based natural history studies evaluating outcome after symptomatic ICA occlusion (SICAO).

Methods--We performed a retrospective, population-based study of SICAO. All Olmsted County (Minnesota) residents with possible SICAO from 1986 to 2000 were identified by cross-referencing appropriate clinical and imaging codes. Inclusion criteria were cerebral infarction or TIA in a carotid distribution and imaging documentation of ipsilateral ICA occlusion <3 months after the index event. Kaplan-Meier estimates were used to calculate the risk of cerebral infarction, myocardial infarction, and death after SICAO.

Results--Seventy-five patients qualified. Annual SICAO incidence was 6 per 100 000 persons (age and gender adjusted to the 2000 US white population). Risk of cerebral infarction during follow-up was 8% at 30 days, 10% at 1 year, and 14% at 5 years. Five of 11 cerebral infarctions occurred within the first week after diagnosis of occlusion. Risk of myocardial infarction was 0% at 30 days, 8% at 1 year, and 24% at 5 years. Risk of death was 7%, 13%, and 29%, respectively.

Conclusions--There may be 15 000 to 20 000 incident cases of SICAO in the United States annually. Risk of cerebral infarction after SICAO is initially high and then stabilizes, whereas risk of myocardial infarction is initially low but gradually increases. Better strategies are needed to reduce early stroke recurrence in this setting.

Key words: carotid arteries • occlusion • cerebral infarction • cerebral ischemia, transient

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