Endovascular Management vs Intravenous Thrombolysis for Acute Stroke Secondary to Carotid Artery Dissection: Local Experience and Systematic Review.
BACKGROUND
Little is known regarding the endovascular management of acute ischemic stroke (AIS) related to carotid artery dissection (CAD).


OBJECTIVE
To report our interventional experience in AIS from CAD and to compare it with conservative treatment of CAD with intravenous thrombolysis (IVT) via systematic review.


METHODS
Retrospective analysis of consecutive high-grade steno-occlusive CAD with National Institutes of Health Stroke Scale (NIHSS) >5 and ≤12 hours of last seen normal from 2 tertiary centers. A systematic review for studies on IVT in the setting of CAD via PubMed was performed for comparison.


RESULTS
Of 1112 patients treated with endovascular interventions within the study period, 21 met the inclusion criteria. Mean age was 52.0 ± 10.9 years, 76% were male, NIHSS was 17.4 ± 5.8, 52% received IVT before intervention, and 90% had tandem occlusions. Mean time from last-known-normal to puncture was 4.8 ± 2.1 hours and procedure length 1.8 ± 1.0 hours. Stents were used in 52% of cases, and reperfusion (modified Treatment in Cerebral Ischemia 2b-3) achieved in 95%. No parenchymal hemorrhages were observed and 71% achieved good outcome (90-day modified Rankin Scale 0-2). The literature review identified 8 studies concerning thrombolysis in the CAD setting fitting inclusion criteria (n = 133). Our endovascular experience compared with the pooled IVT reports indicated that, despite presenting with higher NIHSS (17 vs 14; P = .04) and experiencing a longer time to definitive therapy (287 vs 162 minutes; P < .01), patients treated intra-arterially had similar rates of symptomatic cerebral/European Cooperative Acute Stroke Study-parenchymal hematoma 2 hemorrhage (0% vs 6%; P = .43) and good outcomes (71% vs 52%; P = .05).


CONCLUSIONS
Our study provides evidence that the endovascular management of AIS in the setting of CAD is a feasible, safe, and promising strategy.
*Emory University School of Medicine/Marcus Stroke and Neuroscience Center-Grady Memorial Hospital, Atlanta, Georgia;‡University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania;§Atlanta Medical Center, Atlanta, Georgia.
Diogo C
DC
Haussen
Ashutosh
A
Jadhav
Tudor
T
Jovin
Jonathan A
JA
Grossberg
Mikayel
M
Grigoryan
Fadi
F
Nahab
Mahmoud
M
Obideen
Andrey
A
Lima
Amin
A
Aghaebrahim
Deepak
D
Gulati
Raul G
RG
Nogueira
D000368:Aged; D020215:Carotid Artery, Internal, Dissection / Q000601:surgery / Q000628:therapy*; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000601:surgery / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000379:methods*