Intravenous Thrombolysis in Cervical Artery Dissection-Related Stroke: A Nationwide Study

Although intravenous thrombolysis (IVT) is safe and effective in populations with general stroke, its impact on cervical artery dissection-related acute ischemic stroke (CeAD-AIS) remains unclear. This retrospective study used the National Inpatient Sample to compare outcomes in patients with CeAD-AIS treated with and without IVT.

We included adult patients with concurrent CeAD and AIS diagnoses (International Classification of Diseases, Tenth Revision [ICD-10], codes) hospitalized from 2016 to 2019. The primary outcome was home discharge; safety outcomes included inpatient death and intracerebral hemorrhage. We performed survey-weighted multivariable logistic regressions comparing IVT versus no IVT, followed by interaction analyses to examine effect modifications based on age, medical history, stroke severity, carotid artery involvement, and endovascular treatment.

Between 2016 and 2019, 1360 (12.1%) of 11 285 patients with CeAD-AIS received IVT. IVT-treated patients had higher median National Institutes of Health Stroke Scale scores (median [interquartile range], 8 [4-17] versus 3 [1-11]; P<0.001). Adjusted analyses showed IVT was associated with higher odds of home discharge (adjusted odds ratio [OR], 1.40 [95% CI, 1.01-1.92]; P=0.042), but not with inpatient death (adjusted OR, 1.29 [95% CI, 0.76-2.20]; P=0.347) or intracerebral hemorrhage (adjusted OR, 0.69 [95% CI, 0.32-1.48]; P=0.341). Stroke severity (P for interaction=0.001) and carotid artery involvement (P for interaction=0.021) significantly modified IVT's effect on home discharge, with IVT being associated with an increased likelihood of home discharge in patients with moderate to severe strokes (National Institutes of Health Stroke Scale score >4) and carotid artery involvement.

IVT improves the likelihood of home discharge in patients with CeAD-AIS without increasing the risk of inpatient death or intracerebral hemorrhage.