title: Safety and functional outcome of thrombolysis in dissection-related ischemic stroke: a meta-analysis of individual patient data.
abstract: OBJECTIVE
  The safety and efficacy of thrombolysis in cervical artery dissection (CAD) are controversial. The aim of this meta-analysis was to pool all individual patient data and provide a valid estimate of safety and outcome of thrombolysis in CAD.
  
  
  METHODS
  We performed a systematic literature search on intravenous and intra-arterial thrombolysis in CAD. We calculated the rates of pooled symptomatic intracranial hemorrhage and mortality and indirectly compared them with matched controls from the Safe Implementation of Thrombolysis in Stroke-International Stroke Thrombolysis Register. We applied multivariate regression models to identify predictors of excellent (modified Rankin Scale=0 to 1) and favorable (modified Rankin Scale=0 to 2) outcome.
  
  
  RESULTS
  We obtained individual patient data of 180 patients from 14 retrospective series and 22 case reports. Patients were predominantly female (68%), with a mean±SD age of 46±11 years. Most patients presented with severe stroke (median National Institutes of Health Stroke Scale score=16). Treatment was intravenous thrombolysis in 67% and intra-arterial thrombolysis in 33%. Median follow-up was 3 months. The pooled symptomatic intracranial hemorrhage rate was 3.1% (95% CI, 1.3 to 7.2). Overall mortality was 8.1% (95% CI, 4.9 to 13.2), and 41.0% (95% CI, 31.4 to 51.4) had an excellent outcome. Stroke severity was a strong predictor of outcome. Overlapping confidence intervals of end points indicated no relevant differences with matched controls from the Safe Implementation of Thrombolysis in Stroke-International Stroke Thrombolysis Register.
  
  
  CONCLUSIONS
  Safety and outcome of thrombolysis in patients with CAD-related stroke appear similar to those for stroke from all causes. Based on our findings, thrombolysis should not be withheld in patients with CAD.
authors.affiliation: Department of Neurology, H2.216, Academic Medical Center, PO Box 22660, 1100 DD Amsterdam, the Netherlands.
authors.forename: Sanne M
authors.initials: SM
authors.lastname: Zinkstok
authors.forename: Mervyn D I
authors.initials: MD
authors.lastname: Vergouwen
authors.forename: Stefan T
authors.initials: ST
authors.lastname: Engelter
authors.forename: Philippe A
authors.initials: PA
authors.lastname: Lyrer
authors.forename: Leo H
authors.initials: LH
authors.lastname: Bonati
authors.forename: Marcel
authors.initials: M
authors.lastname: Arnold
authors.forename: Heinrich P
authors.initials: HP
authors.lastname: Mattle
authors.forename: Urs
authors.initials: U
authors.lastname: Fischer
authors.forename: Hakan
authors.initials: H
authors.lastname: Sarikaya
authors.forename: Ralf W
authors.initials: RW
authors.lastname: Baumgartner
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Georgiadis
authors.forename: Céline
authors.initials: C
authors.lastname: Odier
authors.forename: Patrik
authors.initials: P
authors.lastname: Michel
authors.forename: Jukka
authors.initials: J
authors.lastname: Putaala
authors.forename: Martin
authors.initials: M
authors.lastname: Griebe
authors.forename: Nils
authors.initials: N
authors.lastname: Wahlgren
authors.forename: Niaz
authors.initials: N
authors.lastname: Ahmed
authors.forename: Nan
authors.initials: N
authors.lastname: van Geloven
authors.forename: Rob J
authors.initials: RJ
authors.lastname: de Haan
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Nederkoorn
mesh_terms: D002545:Brain Ischemia / Q000209:etiology / Q000628:therapy*; D002340:Carotid Artery Diseases / Q000150:complications / Q000628:therapy*; D005260:Female; D006801:Humans; D020300:Intracranial Hemorrhages / Q000209:etiology / Q000628:therapy; D008297:Male; D015201:Meta-Analysis as Topic; D020521:Stroke / Q000209:etiology / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000379:methods*