{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T19:20:17Z","timestamp":1792783217521,"version":"4.5.0"},"reference-count":18,"publisher":"Springer Science and Business Media LLC","issue":"2","license":[{"start":{"date-parts":[[2019,11,7]],"date-time":"2019-11-07T00:00:00Z","timestamp":1573084800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2019,11,7]],"date-time":"2019-11-07T00:00:00Z","timestamp":1573084800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100004063","name":"Knut och Alice Wallenbergs Stiftelse","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100004063","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100002960","name":"V\u00e4sterbotten L\u00e4ns Landsting","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100002960","id-type":"DOI","asserted-by":"publisher"}]},{"name":"The research fund for neurological research at the university hospital of northern Sweden"},{"name":"The Swedish Stroke Fund"},{"name":"The Northern Swedish Stroke fund"},{"name":"The Swedish Medical Association","id":[{"id":"https:\/\/ror.org\/04hdh0n29","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Neurol"],"published-print":{"date-parts":[[2020,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To assess the risk of recurrent ipsilateral ischemic stroke in patients with symptomatic near-occlusion with and without full collapse.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Included were consecutive patients eligible for revascularization, grouped into symptomatic conventional \u2265\u200950% carotid stenosis (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009266), near-occlusion without full collapse (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200957) and near-occlusion with full collapse (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200942). The risk of preoperative recurrent ipsilateral ischemic stroke was analyzed, or, for cases not revascularized within 90\u00a0days, 90-day risk was analyzed.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The risk of a preoperative recurrent ipsilateral ischemic stroke or ipsilateral retinal artery occlusion was 15% (95% CI 9\u201320%) for conventional \u2265\u200950% stenosis, 22% (95% CI 6\u201338%) among near-occlusion without full collapse and 30% (95% CI 16\u201344%) among near-occlusion with full collapse (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.01, log rank test). In multivariate analysis, near-occlusion with full collapse had a higher risk of recurrent ipsilateral ischemic stroke (adjusted HR 2.6, 95% CI 1.3\u20135.3) and near-occlusion without full collapse tended to have a higher risk (adjusted HR 2.0, 95% CI 0.9\u20134.5) than conventional\u2009\u2265\u200950% stenosis. Only 24% of near-occlusion with full collapse underwent revascularization, common causes for abstaining were misdiagnosis as occlusion (31%), deemed surgically unfeasible (21%) and low perceived benefit (10%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Symptomatic carotid near-occlusion has a high short-term risk of recurrent ipsilateral ischemic stroke, especially near-occlusion with full collapse.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00415-019-09605-5","type":"journal-article","created":{"date-parts":[[2019,11,7]],"date-time":"2019-11-07T07:03:21Z","timestamp":1573110201000},"page":"522-530","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":39,"title":["Symptomatic carotid near-occlusion causes a high risk of recurrent ipsilateral ischemic stroke"],"prefix":"10.1007","volume":"267","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0560-3578","authenticated-orcid":false,"given":"Thomas","family":"Gu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard I.","family":"Aviv","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allan J.","family":"Fox","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elias","family":"Johansson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2019,11,7]]},"reference":[{"key":"9605_CR1","doi-asserted-by":"publisher","first-page":"2","DOI":"10.3174\/ajnr.A4432","volume":"37","author":"E Johansson","year":"2016","unstructured":"Johansson E, Fox AJ (2016) Carotid near-occlusion: a comprehensive review, part 1\u2014definition, terminology, and diagnosis. Am J Neuroradiol 37:2\u201310","journal-title":"Am J Neuroradiol"},{"key":"9605_CR2","doi-asserted-by":"publisher","first-page":"200","DOI":"10.3174\/ajnr.A4429","volume":"37","author":"E Johansson","year":"2016","unstructured":"Johansson E, Fox AJ (2016) Carotid near-occlusion: a comprehensive review, part 2\u2014prognosis and treatment, pathophysiology, confusions, and areas for improvement. Am J Neuroradiol 37:200\u2013204","journal-title":"Am J Neuroradiol"},{"key":"9605_CR3","first-page":"2086","volume":"26","author":"AJ Fox","year":"2005","unstructured":"Fox AJ, Eliasziw M, Rothwell PM et al (2005) Identification, prognosis, and management of patients with carotid artery near occlusion. Am J Neuroradiol 26:2086\u20132094","journal-title":"Am J Neuroradiol"},{"key":"9605_CR4","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1016\/j.ejvs.2017.06.021","volume":"55","author":"AR Naylor","year":"2018","unstructured":"Naylor AR, Ricco JB, de Borst GJ et al (2018) Management of atherosclerotic carotid and vertebral artery disease: 2017 clinical practice guidelines of the european society for vascular surgery (ESVS). Eur J Vasc Endovasc Surg 55:3\u201381","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"9605_CR5","doi-asserted-by":"publisher","first-page":"e54","DOI":"10.1161\/CIR.0b013e31820d8d78","volume":"124","author":"TG Brott","year":"2011","unstructured":"Brott TG, Halperin JL, Abbara S et al (2011) 2011 ASA\/ACCF\/AHA\/AANN\/AANS\/ACR\/ ASNR\/CNS\/SAIP\/SCAI\/SIR\/SNIS\/SVM\/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease. Circulation 124:e54\u2013130","journal-title":"Circulation"},{"key":"9605_CR6","doi-asserted-by":"publisher","first-page":"615","DOI":"10.1111\/joim.12318","volume":"277","author":"E Johansson","year":"2015","unstructured":"Johansson E, \u00d6hman K, Wester P (2015) Symptomatic carotid near-occlusion with full collapse might cause a very high risk of stroke. J Intern Med 277:615\u2013623","journal-title":"J Intern Med"},{"key":"9605_CR7","doi-asserted-by":"publisher","first-page":"713","DOI":"10.1177\/1747493017714177","volume":"12","author":"A Garc\u00eda-Pastor","year":"2017","unstructured":"Garc\u00eda-Pastor A, Gil-N\u00fa\u00f1ez A, Ram\u00edrez-Moreno JM et al (2017) Early risk of recurrent stroke in patients with symptomatic carotid near-occlusion: results from CAOS, a multicenter registry study. Int J Stroke 12:713\u2013719","journal-title":"Int J Stroke"},{"key":"9605_CR8","first-page":"632","volume":"27","author":"ES Bartlett","year":"2006","unstructured":"Bartlett ES, Walters TD, Symons SP, Fox AJ (2006) Diagnosing carotid stenosis near-occlusion by using CT angiography. Am J Neuroradiol 27:632\u2013637","journal-title":"Am J Neuroradiol"},{"key":"9605_CR9","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1007\/s00234-017-1792-4","volume":"59","author":"E Johansson","year":"2017","unstructured":"Johansson E, Fox AJ (2017) Diagnosing carotid near-occlusion with 1 mm side-to-side asymmetry: a tough task made too easy. Neuroradiol 59:319\u2013321","journal-title":"Neuroradiol"},{"key":"9605_CR10","doi-asserted-by":"publisher","first-page":"316","DOI":"10.1148\/radiology.186.2.8421726","volume":"186","author":"AJ Fox","year":"1993","unstructured":"Fox AJ (1993) How to measure carotid stenosis. Radiology 186:316\u2013318","journal-title":"Radiology"},{"key":"9605_CR11","first-page":"541","volume":"54","author":"S Hatano","year":"1976","unstructured":"Hatano S (1976) Experience from multicenter stroke register: a preliminary report. Bull World Health Organ 54:541\u2013553","journal-title":"Bull World Health Organ"},{"key":"9605_CR12","unstructured":"The World Health Organization ICD 11. \nhttps:\/\/icd.who.int\/\n\n. Accessed 15 Feb 2019"},{"key":"9605_CR13","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1016\/S0140-6736(03)12228-3","volume":"361","author":"PM Rothwell","year":"2003","unstructured":"Rothwell PM, Eliasziw M, Gutnikov SA, Carotid Endarterectomy Trialists\u2019 Collaboration et al (2003) Analysis of pooled data from the randomized controlled trials of endarterectomy for symptomatic carotid stenosis. Lancet 361:107\u2013116","journal-title":"Lancet"},{"key":"9605_CR14","doi-asserted-by":"publisher","first-page":"665","DOI":"10.1002\/bjs.11159","volume":"106","author":"AJA Meershoek","year":"2019","unstructured":"Meershoek AJA, de Vries EE, Veen D, den Ruijter HM, de Borst GF, for the NEON Study Group (2019) Meta-analysis of the outcomes of treatment of internal carotid artery near occlusion. Br J Surg 106:665\u2013671","journal-title":"Br J Surg"},{"key":"9605_CR15","doi-asserted-by":"publisher","first-page":"498","DOI":"10.1212\/WNL.0000000000002354","volume":"86","author":"E Johansson","year":"2016","unstructured":"Johansson E, Cuadrado-Godia E, Hayden D et al (2016) Recurrent stroke in symptomatic carotid stenosis awaiting revascularisation\u2014a pooled analysis. Neurology 86:498\u2013504","journal-title":"Neurology"},{"key":"9605_CR16","doi-asserted-by":"publisher","first-page":"1900","DOI":"10.1007\/s00415-018-8939-z","volume":"265","author":"AJA Meershoek","year":"2018","unstructured":"Meershoek AJA, Vonken EPA, Nederkoorn PJ, Kappelle LJ, de Borst GJ (2018) Carotid endarterectomy in patients with recurrent symptoms associated with an ipsilateral carotid artery near-occlusion with full collapse. J Neurol 265:1900\u20131905","journal-title":"J Neurol"},{"key":"9605_CR17","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1007\/s00234-017-1938-4","volume":"60","author":"SR Khangure","year":"2018","unstructured":"Khangure SR, Benhabib H, Machnowska M et al (2018) Carotid near-occlusion frequently has high peak systolic velocity on Doppler ultrasound. Neuroradiology 60:17\u201325","journal-title":"Neuroradiology"},{"key":"9605_CR18","doi-asserted-by":"publisher","first-page":"220","DOI":"10.1111\/j.1747-4949.2012.00790.x","volume":"8","author":"E Johansson","year":"2013","unstructured":"Johansson E, Arnerl\u00f6v C, Wester P (2013) Risk of recurrent stroke before carotid endarterectomy: the ANSYSCAP study. Int J Stroke 8:220\u2013227","journal-title":"Int J Stroke"}],"container-title":["Journal of Neurology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1007\/s00415-019-09605-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1007\/s00415-019-09605-5\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1007\/s00415-019-09605-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,11,5]],"date-time":"2020-11-05T19:11:34Z","timestamp":1604603494000},"score":1,"resource":{"primary":{"URL":"http:\/\/link.springer.com\/10.1007\/s00415-019-09605-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,11,7]]},"references-count":18,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2020,2]]}},"alternative-id":["9605"],"URL":"https:\/\/doi.org\/10.1007\/s00415-019-09605-5","relation":{},"ISSN":["0340-5354","1432-1459"],"issn-type":[{"value":"0340-5354","type":"print"},{"value":"1432-1459","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,11,7]]},"assertion":[{"value":"17 September 2019","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 October 2019","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 October 2019","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 November 2019","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"The authors declare that they have no conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflicts of interest"}},{"value":"The study was approved by the regional ethics board in Ume\u00e5, waiving need for informed consent due to the observational design.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}]}}