Antithrombotic treatment of ischemic stroke among patients with occlusion or severe stenosis of the internal carotid artery - A report of the Trial of Org 10172 in Acute Stroke Treatment (TOAST)

Objective: To examine the responses to early IV administration of an antico agulant or placebo started within 24 hours of stroke among persons with an ipsilateral occlusion or severe stenosis of the internal carotid artery (IC A) identified by carotid duplex imaging. Background: Patients with ischemic stroke of the cerebral hemisphere secondary to an ipsilateral occlusion or severe stenosis of the ICA generally have a poor prognosis. Early, accurat e identification of these patients might permit improved treatment. Methods : Exploratory analysis of outcomes at 7 days and 3 months was performed amo ng patients enrolled in the Trial of Org 10172 in Acute Stroke Treatment (T OAST) who had an ischemic stroke in the cerebral hemisphere ipsilateral to an occlusion or a stenosis >50% of the ICA identified by carotid duplex ima ging. Results: Regardless of treatment, patients with duplex evidence of an occlusion of the ICA had more severe strokes and poorer outcomes at 7 days and 3 months than patients who had a stenosis. Favorable outcomes at 7 day s were noted in 64 of 119 patients given danaparoid (53.8%) and 41 of 108 p atients treated with placebo (38.0%; p = 0.023). By 3 months, favorable out comes were noted in 82 patients given danaparoid (68.3%) and 58 patients ad ministered placebo (53.2%; p = 0.021). Conclusions: Early identification by duplex imaging of an occlusion or severe stenosis of the ICA ipsilateral t o a hemispheric ischemic stroke might improve selection of patients who cou ld be treated with emergent anticoagulation. Further testing of this approa ch is needed.