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Thrombolysis in cervical artery dissection--data from the Cervical Artery Dissection and Ischaemic Stroke Patients

S T Engelter1, J Dallongeville, M Kloss

  • 1Department of Neurology, Basel University Hospital, Basel, Switzerland. sengelter@uhbs.ch

European Journal of Neurology
|March 28, 2012
PubMed

Insights

Thrombolysis for stroke from cervical artery dissection (CeAD) did not worsen outcomes or increase bleeding risk. These findings suggest that thrombolysis should not be withheld in CeAD stroke patients, though further research into more effective treatments is warranted.

Area of Science:

  • Neurology
  • Vascular Medicine
  • Interventional Cardiology

Background:

  • Cervical artery dissection (CeAD) is a significant cause of stroke in younger adults.
  • The role of thrombolysis in CeAD-associated stroke remains controversial due to concerns about hemorrhage risk.

Purpose of the Study:

  • To evaluate the impact of thrombolysis on outcomes and major hemorrhage rates in patients with stroke due to cervical artery dissection (CeAD).

Main Methods:

  • A multicenter CeAD stroke database was used to compare patients treated with and without thrombolysis.
  • Outcomes included favorable 3-month functional status (modified Rankin Scale 0-2) and major hemorrhage (intracranial or extracranial).
  • Adjusted odds ratios and propensity-matched analyses were performed.

Main Results:

  • Among 616 CeAD stroke patients, 68 received thrombolysis, often for more severe strokes and with higher rates of arterial occlusion.
  • Thrombolysis was not independently associated with unfavorable 3-month outcomes (adjusted OR 0.95) or a significant increase in major hemorrhages (5.9% vs 0.6%).
  • Propensity matching confirmed similar favorable outcome odds between thrombolyzed and non-thrombolyzed groups.

Conclusions:

  • Thrombolysis in CeAD stroke is not associated with worse outcomes or excess symptomatic bleeding.
  • These findings support not withholding thrombolysis in CeAD stroke patients.
  • The absence of a clear benefit suggests exploring alternative treatments like mechanical revascularization.
Abstract

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