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Prehospital Thrombolysis: A Manual from Berlin
Published on: November 26, 2013
Intravenous thrombolysis in stroke attributable to cervical artery dissection
Stefan T Engelter1, Matthieu P Rutgers, Florian Hatz
1Stroke Units and Department of Neurology, University Hospitals Basel, Switzerland. sengelter@uhbs.ch
Stroke
|October 17, 2009
Summary
Intravenous thrombolysis (IVT) for cervical artery dissection (CAD) shows less favorable outcomes compared to other stroke causes. However, similar rates of bleeding and recurrent stroke suggest IVT remains a viable treatment option for CAD patients.
Area of Science:
- Neurology
- Vascular Medicine
- Emergency Medicine
Background:
- Cervical artery dissection (CAD) is a significant cause of stroke in younger adults.
- The efficacy and safety of intravenous thrombolysis (IVT) in CAD patients remain under investigation.
- Previous studies suggest IVT benefits stroke patients regardless of etiology.
Purpose of the Study:
- To evaluate the outcomes and complications of IVT in patients with CAD compared to non-CAD stroke patients.
- To determine if IVT is a safe and effective treatment for stroke secondary to CAD.
- To identify factors contributing to potential differences in outcomes.
Main Methods:
- Retrospective analysis of the Swiss IVT databank.
- Comparison of IVT-treated CAD patients (n=55) with non-CAD patients (n=1007).
- Primary outcomes included favorable 3-month outcome (modified Rankin Scale score ≤1), intracranial hemorrhage, and recurrent ischemic stroke.
Main Results:
- CAD patients were younger but had similar stroke severity and treatment times compared to non-CAD patients.
- Favorable 3-month outcome was less frequent in CAD patients (36%) versus non-CAD patients (44%), particularly after age, gender, and NIHSS adjustment (OR, 0.50; P=0.03).
- Rates of intracranial hemorrhage (14% vs. 14%) and recurrent ischemic stroke (1.8% vs. 3.7%) were similar between CAD and non-CAD groups.
Conclusions:
- IVT-treated CAD patients experience less favorable functional recovery compared to non-CAD patients.
- The similar rates of intracranial hemorrhage and recurrent ischemic stroke suggest these complications do not explain the outcome disparity.
- IVT should not be withheld from patients with suspected CAD, as potential factors like hemodynamic compromise or tandem occlusions may influence outcomes.
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