Systemic thrombolysis in patients with acute ischemic stroke and Internal Carotid ARtery Occlusion: the ICARO study.
OBJECTIVE
The beneficial effect of intravenous  thrombolytic therapy in patients with acute ischemic stroke attributable to internal carotid artery (ICA) occlusion remains unclear. The aim of this study was to evaluate the efficacy and safety of intravenous recombinant tissue-type plasminogen activator in these patients.


METHODS
ICARO was a case-control multicenter study on prospectively collected data. Patients with acute ischemic stroke and ICA occlusion treated with intravenous recombinant tissue-type plasminogen activator within 4.5 hours from symptom onset (cases) were compared to matched patients with acute stroke and ICA occlusion not treated with recombinant tissue-type plasminogen activator (controls). Cases and controls were matched for age, gender, and stroke severity. The efficacy outcome was disability at 90 days assessed by the modified Rankin Scale, dichotomized as favorable (score of 0-2) or unfavorable (score of 3-6). Safety outcomes were death and any intracranial bleeding.


RESULTS
Included in the analysis were 253 cases and 253 controls. Seventy-three cases (28.9%) had a favorable outcome as compared with 52 controls (20.6%; adjusted odds ratio (OR), 1.80; 95% confidence interval [CI], 1.03-3.15; P=0.037). A total of 104 patients died, 65 cases (25.7%) and 39 controls (15.4%; adjusted OR, 2.28; 95% CI, 1.36-3.22; P=0.001). There were more fatal bleedings (2.8% versus 0.4%; OR, 7.17; 95% CI, 0.87-58.71; P=0.068) in the cases than in the controls.


CONCLUSIONS
In patients with stroke attributable to ICA occlusion,  thrombolytic therapy results in a significant reduction in the proportion of patients dependent in activities of daily living. Increases in death and any intracranial bleeding were the trade-offs for this clinical benefit.
Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Santa Maria della Misericordia Hospital, Perugia 06126, Italy. mpaciaroni@med.unipg.it
Maurizio
M
Paciaroni
Clotilde
C
Balucani
Giancarlo
G
Agnelli
Valeria
V
Caso
Giorgio
G
Silvestrelli
James C
JC
Grotta
Andrew M
AM
Demchuk
Sung-Il
SI
Sohn
Giovanni
G
Orlandi
Didier
D
Leys
Alessandro
A
Pezzini
Andrei V
AV
Alexandrov
Mauro
M
Silvestrini
Luisa
L
Fofi
Kristian
K
Barlinn
Domenico
D
Inzitari
Carlo
C
Ferrarese
Rossana
R
Tassi
Georgios
G
Tsivgoulis
Domenico
D
Consoli
Antonio
A
Baldi
Paolo
P
Bovi
Emilio
E
Luda
Giampiero
G
Galletti
Paolo
P
Invernizzi
Maria Luisa
ML
DeLodovici
Francesco
F
Corea
Massimo
M
Del Sette
Serena
S
Monaco
Simona
S
Marcheselli
Andrea
A
Alberti
Michele
M
Venti
Monica
M
Acciarresi
Cataldo
C
D'Amore
Federica
F
Macellari
Alessia
A
Lanari
Paolo
P
Previdi
Nicole R
NR
Gonzales
Renganayaki K
RK
Pandurengan
Farhaan S
FS
Vahidy
Melvin
M
Sline
Simerpreet S
SS
Bal
Alberto
A
Chiti
Gino
G
Gialdini
Frederic
F
Dumont
Charlotte
C
Cordonnier
Stéphanie
S
Debette
Alessandro
A
Padovani
Raffaella
R
Cerqua
Ulf
U
Bodechtel
Jessica
J
Kepplinger
Mascia
M
Nesi
Patrizia
P
Nencini
Simone
S
Beretta
Claudia
C
Trentini
Giuseppe
G
Martini
Charitomeni
C
Piperidou
Ioannis
I
Heliopoulos
Sebastiano
S
D'Anna
Manuel
M
Cappellari
Edoardo
E
Donati
Giorgio
G
Bono
Elisabetta
E
Traverso
Danilo
D
Toni
D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000188:drug therapy* / Q000209:etiology; D002343:Carotid Artery, Internal; D016893:Carotid Stenosis / Q000150:complications / Q000188:drug therapy*; D016022:Case-Control Studies; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000188:drug therapy* / Q000209:etiology; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000379:methods; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator