Intravenous thrombolysis in patients with stroke attributable to small artery occlusion.
BACKGROUND
Intravenous thrombolysis (IVT) for stroke seems to be beneficial independent of the underlying etiology. Recent observations raised concern that IVT might cause harm in patients with strokes attributable to small artery occlusion (SAO).


OBJECTIVE
The safety of IVT in SAO-patients is addressed in this study.


METHODS
We used the Swiss IVT databank to compare outcome and complications of IVT-treated SAO-patients with IVT-treated patients with other etiologies (non-SAO-patients). Main outcome and complication measures were independence (modified Rankin scale <or=2) at 3 months, intracranial hemorrhage (ICH), and recurrent ischaemic stroke.


RESULTS
Sixty-five (6.2%) of 1048 IVT-treated patients had SAO. Amongst SAO-patients, 1.5% (1/65) patients died, compared to 11.2% (110/983) in the non-SAO-group (P = 0.014). SAO-patients reached independence more often than non-SAO-patients (75.4% versus 58.9%; OR 2.14 (95% CI 1.20-3.81; P = 0.001). This association became insignificant after adjustment for age, gender, and stroke severity (OR 1.41 95% CI 0.713-2.788; P = 0.32). Glucose level and (to some degree) stroke severity but not age predicted 3-month-independence in IVT-treated SAO-patients. ICHs (all/symptomatic) were similar in SAO- (12.3%/4.6%) and non-SAO-patients (13.4%/5.3%; P > 0.8). Fatal ICH occurred in 3.3% of the non-SAO-patients but none amongst SAO-patients. Ischaemic stroke within 3 months after IVT reoccurred in 1.5% of SAO-patients and in 2.3% of non-SAO-patients (P = 0.68).


CONCLUSIONS
IVT-treated SAO-patients died less often and reached independence more often than IVT-treated non-SAO-patients. However, the variable 'SAO' was a dependent rather than an independent outcome predictor. The absence of an excess in ICH indicates that IVT seems not to be harmful in SAO-patients.
Fluri
F
F
Stroke Units and Neurological Clinics/Department of Neurology, University Hospitals, Basel, Switzerland. flurif@uhbs.ch
Hatz
F
F
Rutgers
M P
MP
Georgiadis
D
D
Sekoranja
L
L
Schwegler
G
G
Sarikaya
H
H
Weder
B
B
Müller
F
F
Lüthy
R
R
Arnold
M
M
Reichhart
M
M
Mattle
H P
HP
Tettenborn
B
B
Nedeltchev
K
K
Hungerbühler
H J
HJ
Sztajzel
R
R
Baumgartner
R W
RW
Michel
P
P
Lyrer
P A
PA
Engelter
S T
ST
D000368:Aged; D000369:Aged, 80 and over; D001157:Arterial Occlusive Diseases / Q000150:complications*; D002545:Brain Ischemia / Q000209:etiology* / Q000628:therapy*; D016009:Chi-Square Distribution; D016208:Databases, Factual; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012008:Recurrence; D020521:Stroke / Q000209:etiology* / Q000628:therapy*; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator