Thrombolysis in patients with acute stroke caused by cervical artery dissection: analysis of 9 patients and review of the literature.
BACKGROUND
Results of recently published studies suggest that intravenous thrombolysis (IVT) and local intra-arterial thrombolysis (LIT) are feasible procedures in acute stroke after cervical artery dissection (CAD).


OBJECTIVE
To describe 9 patients with acute stroke caused by CAD who were treated by LIT (n = 7) or IVT (n = 2) and to review the literature.


METHODS
Retrospective analysis of clinical and neuroradiological findings; literature review from 1980 to present.


METHODS
Modified Rankin Scale (mRS) score.


RESULTS
Of 7 patients treated with LIT, 3 had good outcomes (mRS score of 0-2) and 4 had bad outcomes (mRS score of 3-6) at 3 months. The 2 patients who had received IVT recovered to mRS scores of 0 and 3. Twenty-one patients were identified in the literature. Overall (N = 30), in the IVT group (n = 19), the outcome was good in 8 patients (42%) and bad in 11 (58%); in the LIT group (n = 11), 6 patients (55%) had a good outcome and 5 (45%) had a bad outcome. Overall, 47% (14/30) of the patients (IVT and LIT groups) had a good outcome. Total mortality was 13% (4/30). There were no secondary complications due to extension of wall hematoma or angiography. One symptomatic hemorrhage occurred.


CONCLUSIONS
Thrombolysis is feasible in acute stroke caused by CAD. Local complications from extension of wall hematoma did not occur. Further prospective studies are needed to determine the safety and efficacy of thrombolysis in the special circumstance of acute stroke caused by CAD.
Arnold
Marcel
M
Department of Neurology, University of Berne, Inselspital, CH-3010 Berne, Switzerland. heinrich.mattle@insel.ch
Nedeltchev
Krassen
K
Sturzenegger
Matthias
M
Schroth
Gerhard
G
Loher
Thomas J
TJ
Stepper
Frank
F
Remonda
Luca
L
Bassetti
Claudio
C
Mattle
Heinrich P
HP
D000208:Acute Disease; D000328:Adult; D000368:Aged; D002533:Cerebral Angiography; D002574:Cervical Vertebrae / Q000098:blood supply*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000188:drug therapy / Q000209:etiology; D007269:Injections, Intra-Arterial; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D010960:Plasminogen Activators / Q000008:administration & dosage*; D012189:Retrospective Studies; D020521:Stroke / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology*; D015912:Thrombolytic Therapy / Q000379:methods; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage; D020217:Vertebral Artery Dissection / Q000150:complications*
D010960:Plasminogen Activators; D010959:Tissue Plasminogen Activator; D014568:Urokinase-Type Plasminogen Activator