Intravenous thrombolysis in stroke attributable to cervical artery dissection

Publication

Intravenous thrombolysis in stroke attributable to cervical artery dissection

Journal Paper/Review - Oct 15, 2009

Engelter Stefan T, Nedeltchev Krassen, Reichhart Marc, Mattle Heinrich P, Tettenborn Barbara, Hungerbühler Hansjörg J, Sztajzel Roman, Baumgartner Ralf W, Michel Patrik, Arnold Marcel, Lüthy Regina, Sarikaya Hakan, Rutgers Matthieu P, Hatz Florian, Georgiadis Dimitrios, Fluri Felix, Sekoranja Lucka, Schwegler Guido, Müller Felix, Weder Bruno, Lyrer Philippe A

Citation

Engelter S, Nedeltchev K, Reichhart M, Mattle H, Tettenborn B, Hungerbühler H, Sztajzel R, Baumgartner R, Michel P, Arnold M, Lüthy R, Sarikaya H, Rutgers M, Hatz F, Georgiadis D, Fluri F, Sekoranja L, Schwegler G, Müller F, Weder B, Lyrer P. Intravenous thrombolysis in stroke attributable to cervical artery dissection. Stroke 2009; 40:3772-6.

Type

Journal Paper/Review (English)

Journal

Stroke 2009; 40

Publication Date

Oct 15, 2009

Issn Electronic

1524-4628

Pages

3772-6

Brief description/objective

BACKGROUND AND PURPOSE
Intravenous thrombolysis (IVT) for stroke seems to be beneficial independent of the underlying etiology. Whether this is also true for cervical artery dissection (CAD) is addressed in this study.

METHODS
We used the Swiss IVT databank to compare outcome and complications of IVT-treated patients with CAD with IVT-treated patients with other etiologies (non-CAD patients). Main outcome and complication measures were favorable 3-month outcome, intracranial cerebral hemorrhage, and recurrent ischemic stroke. Modified Rankin Scale score
RESULTS
Fifty-five (5.2%) of 1062 IVT-treated patients had CAD. Patients with CAD were younger (median age 50 versus 70 years) but had similar median National Institutes of Health Stroke Scale scores (14 versus 13) and time to treatment (152.5 versus 156 minutes) as non-CAD patients. In the CAD group, 36% (20 of 55) had a favorable 3-month outcome compared with 44% (447 of 1007) non-CAD patients (OR, 0.72; 95% CI, 0.41 to 1.26), which was less favorable after adjustment for age, gender, and National Institutes of Health Stroke Scale score (OR, 0.50; 95% CI, 0.27 to 0.95; P=0.03). Intracranial cerebral hemorrhages (asymptomatic, symptomatic, fatal) were equally frequent in CAD (14% [7%, 7%, 2%]) and non-CAD patients (14% [9%, 5%, 2%]; P=0.99). Recurrent ischemic stroke occurred in 1.8% of patients with CAD and in 3.7% of non-CAD-patients (P=0.71).

CONCLUSIONS
IVT-treated patients with CAD do not recover as well as IVT-treated non-CAD patients. However, intracranial bleedings and recurrent ischemic strokes were equally frequent in both groups. They do not account for different outcomes and indicate that IVT should not be excluded in patients who may have CAD. Hemodynamic compromise or frequent tandem occlusions might explain the less favorable outcome of patients with CAD.