Acute anterior choroidal artery infarction: Clinical predictors of prognosis

Abstract

Objectives: The clinical and prognostic features of acute anterior choroidal artery (AChA) stroke have not been sufficiently investigated in the context of new treatment approaches.

Methods: This AChA stroke study was a prospective, observational cohort study conducted at a stroke center from July 1, 2020, to September 30, 2024, enrolling patients aged 28 to 85 years within 48 hours of symptom onset. Demographic and clinical characteristics were analyzed for all patients. Clinical characteristics were compared between groups with good outcomes (modified Rankin Scale score, 0-2) and poor outcomes (modified Rankin Scale score, 3-6), as well as between those treated with or without intravenous rt- PA or endovascular treatment.

Results: 115 patients were studied. An NIHSS score of 6 or more at discharge increased the risk of poor outcome (P <0.001). Multivariable regression analysis showed that age (P = 0.04), smoking (P = 0.009), infarct size >15 mm (P = 0.036), and clinical progression (P < 0.001) were positively associated with poor outcome, whereas dual antiplatelet treatment was negatively associated with poor outcome (P = 0.014). Despite thrombolysis, 16 of 30 patients (53%) had an mRS score >2 at 90 days (P <0.005). Thrombectomy was performed in 18 patients, and 10 of them (56%) had mRS scores >2 at 90 days, compared to 8 (44%) with mRS scores ≤2 (P =0.023).

Conclusion: There was no benefit from the thrombolysis within the therapeutic window in patients with AChA strokes. Additional treatments are needed and therapeutic trials should be designed, for example, new dual antiplatelet agents, bridging strategies such as thrombectomy after thrombolysis.