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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Reperfusion therapy in patients with acute ischaemic stroke caused by cervical artery dissection
L A Crespo Araico1, R Vera Lechuga1, A Cruz-Culebras1
1Servicio de Neurología, Hospital Universitario Ramón y Cajal, Departamento de Neurología, Facultad de Medicina, Universidad de Alcalá (IRYCIS), Madrid, España.
Insights
Cervical artery dissection (CAD) often causes stroke in young adults. Reperfusion therapy, including fibrinolysis and endovascular treatment, appears safe and effective for acute CAD, with good functional outcomes.
Area of Science:
- Neurology
- Vascular Medicine
- Stroke Research
Background:
- Cervical artery dissection (CAD) accounts for up to 20% of ischemic strokes in individuals under 45.
- The efficacy of acute reperfusion therapy for CAD remains under investigation.
Purpose of the Study:
- To evaluate the safety and effectiveness of acute-phase reperfusion therapy in patients with cervical artery dissection (CAD).
Main Methods:
- Retrospective review of 35 patients with CAD (carotid or vertebral) admitted between 2010 and 2015.
- Analysis of clinical characteristics, treatments (intravenous fibrinolysis, endovascular treatment), functional outcomes (modified Rankin Scale), and mortality.
Main Results:
- Ischemic stroke was the most common presentation (93.5%) in patients with CAD.
- Reperfusion therapy was administered to 22.6% (intravenous fibrinolysis) and 35.5% (endovascular + fibrinolysis) of patients.
- Functional independence at 3 months was achieved by 57.1% and 63.6% of patients receiving these treatments, respectively.
Conclusions:
- Ischemic stroke is the primary manifestation of CAD.
- Reperfusion therapy shows promise as a safe and effective treatment for acute CAD, yielding outcomes comparable to other ischemic stroke patients.
- Further large-scale comparative studies are needed to definitively assess reperfusion therapy's response in acute ischemic stroke due to CAD.
Introduction:
Cervical artery dissection (CAD) is responsible for up to 20% of all ischaemic strokes in patients younger than 45. The benefits of acute-phase reperfusion therapy in these patients have yet to be confirmed.
Methods:
We conducted a retrospective review of patients with CAD admitted to a comprehensive stroke centre between 2010 and 2015. We recorded baseline clinical characteristics, treatments, functional outcomes, and mortality.
Results:
We identified 35 cases of CAD (23 carotid/12 vertebral); mean age was 43.5 ± 9.5 years and 67.7% were men. Ten patients (32.3%) had a history of trauma. The most frequent risk factors were arterial hypertension (29%) and smoking (35.5%). The most common clinical presentation was ischaemic stroke (29 patients, 93.5%). The median baseline National Institute of Health Stroke Scale score was 6 (range, 0-41). The most frequently used diagnostic method was CT angiography (74.2%), followed by MRI (64.5%) and digital subtraction angiography (45.6%). Seven patients (22.6%) were treated with intravenous fibrinolysis and 11 (35.5%) with endovascular treatment plus intravenous fibrinolysis; at 3 months, functional independence (modified Rankin Scale scores 0-2) was achieved by 57.1% and 63.6% of these cases, respectively. One patient died (3.2%).
Conclusions:
In our sample, the most common form of presentation of CAD was ischaemic stroke. Reperfusion therapy seems to be a safe and effective option for these patients, and outcomes resemble those of other patients with ischaemic stroke. Larger comparative studies are necessary to better assess response to reperfusion therapy in acute ischaemic stroke.
