Intravenous thrombolysis in stroke attributable to cervical artery dissection.
OBJECTIVE
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.
Engelter
Stefan T
ST
Stroke Units and Department of Neurology, University Hospitals Basel, Switzerland. sengelter@uhbs.ch
Rutgers
Matthieu P
MP
Hatz
Florian
F
Georgiadis
Dimitrios
D
Fluri
Felix
F
Sekoranja
Lucka
L
Schwegler
Guido
G
Müller
Felix
F
Weder
Bruno
B
Sarikaya
Hakan
H
Lüthy
Regina
R
Arnold
Marcel
M
Nedeltchev
Krassen
K
Reichhart
Marc
M
Mattle
Heinrich P
HP
Tettenborn
Barbara
B
Hungerbühler
Hansjörg J
HJ
Sztajzel
Roman
R
Baumgartner
Ralf W
RW
Michel
Patrik
P
Lyrer
Philippe A
PA
D000368:Aged; D002340:Carotid Artery Diseases / Q000150:complications* / Q000401:mortality; D002343:Carotid Artery, Internal; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000188:drug therapy* / Q000209:etiology* / Q000401:mortality; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D020217:Vertebral Artery Dissection / Q000150:complications* / Q000401:mortality