title: Intravenous thrombolysis in stroke attributable to cervical artery dissection.
abstract: 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.
authors.affiliation: Stroke Units and Department of Neurology, University Hospitals Basel, Switzerland. sengelter@uhbs.ch
authors.forename: Stefan T
authors.initials: ST
authors.lastname: Engelter
authors.forename: Matthieu P
authors.initials: MP
authors.lastname: Rutgers
authors.forename: Florian
authors.initials: F
authors.lastname: Hatz
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Georgiadis
authors.forename: Felix
authors.initials: F
authors.lastname: Fluri
authors.forename: Lucka
authors.initials: L
authors.lastname: Sekoranja
authors.forename: Guido
authors.initials: G
authors.lastname: Schwegler
authors.forename: Felix
authors.initials: F
authors.lastname: Müller
authors.forename: Bruno
authors.initials: B
authors.lastname: Weder
authors.forename: Hakan
authors.initials: H
authors.lastname: Sarikaya
authors.forename: Regina
authors.initials: R
authors.lastname: Lüthy
authors.forename: Marcel
authors.initials: M
authors.lastname: Arnold
authors.forename: Krassen
authors.initials: K
authors.lastname: Nedeltchev
authors.forename: Marc
authors.initials: M
authors.lastname: Reichhart
authors.forename: Heinrich P
authors.initials: HP
authors.lastname: Mattle
authors.forename: Barbara
authors.initials: B
authors.lastname: Tettenborn
authors.forename: Hansjörg J
authors.initials: HJ
authors.lastname: Hungerbühler
authors.forename: Roman
authors.initials: R
authors.lastname: Sztajzel
authors.forename: Ralf W
authors.initials: RW
authors.lastname: Baumgartner
authors.forename: Patrik
authors.initials: P
authors.lastname: Michel
authors.forename: Philippe A
authors.initials: PA
authors.lastname: Lyrer
mesh_terms: 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