Intravenous thrombolysis in stroke attributable to cervical artery dissection

Engelter, Stefan T; Rutgers, Matthieu P; Hatz, Florian; Georgiadis, Dimitrios; Fluri, Felix; Sekoranja, Lucka; Schwegler, Guido; Müller, Felix; Weder, Bruno; Sarikaya, Hakan; Lüthy, Regina; Arnold, Marcel; Nedeltchev, Krassen; Reichhart, Marc; Mattle, Heinrich P; Tettenborn, Barbara; Hungerbühler, Hansjörg J; Sztajzel, Roman; Baumgartner, Ralf W; Michel, Patrik; ... (2009). Intravenous thrombolysis in stroke attributable to cervical artery dissection. Stroke, 40(12), pp. 3772-6. Baltimore, Md.: Lippincott Williams & Wilkins 10.1161/STROKEAHA.109.555953

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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 <or=1 at 3 months was considered favorable. 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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology

UniBE Contributor:

Weder, Bruno J.; Arnold, Marcel and Mattle, Heinrich

ISSN:

0039-2499

Publisher:

Lippincott Williams & Wilkins

Language:

English

Submitter:

Factscience Import

Date Deposited:

04 Oct 2013 15:13

Last Modified:

04 May 2014 23:23

Publisher DOI:

10.1161/STROKEAHA.109.555953

PubMed ID:

19834022

Web of Science ID:

000272663900018

URI:

https://boris.unibe.ch/id/eprint/32171 (FactScience: 197130)

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