| Intravenous thrombolysis in stroke attributable to cervical artery dissection. | |
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MedLine Citation:
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PMID: 19834022 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND AND PURPOSE: Intravenous thrombolysis (IVT) for stroke seems to be beneficial independent of the underlying etiology. Whether this is also true for cervical artery dissection (CAD) is addressed in this study. METHODS: We used the Swiss IVT databank to compare outcome and complications of IVT-treated patients with CAD with IVT-treated patients with other etiologies (non-CAD patients). Main outcome and complication measures were favorable 3-month outcome, intracranial cerebral hemorrhage, and recurrent ischemic stroke. Modified Rankin Scale score <or=1 at 3 months was considered favorable. RESULTS: Fifty-five (5.2%) of 1062 IVT-treated patients had CAD. Patients with CAD were younger (median age 50 versus 70 years) but had similar median National Institutes of Health Stroke Scale scores (14 versus 13) and time to treatment (152.5 versus 156 minutes) as non-CAD patients. In the CAD group, 36% (20 of 55) had a favorable 3-month outcome compared with 44% (447 of 1007) non-CAD patients (OR, 0.72; 95% CI, 0.41 to 1.26), which was less favorable after adjustment for age, gender, and National Institutes of Health Stroke Scale score (OR, 0.50; 95% CI, 0.27 to 0.95; P=0.03). Intracranial cerebral hemorrhages (asymptomatic, symptomatic, fatal) were equally frequent in CAD (14% [7%, 7%, 2%]) and non-CAD patients (14% [9%, 5%, 2%]; P=0.99). Recurrent ischemic stroke occurred in 1.8% of patients with CAD and in 3.7% of non-CAD-patients (P=0.71). CONCLUSIONS: IVT-treated patients with CAD do not recover as well as IVT-treated non-CAD patients. However, intracranial bleedings and recurrent ischemic strokes were equally frequent in both groups. They do not account for different outcomes and indicate that IVT should not be excluded in patients who may have CAD. Hemodynamic compromise or frequent tandem occlusions might explain the less favorable outcome of patients with CAD. |
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Authors:
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Stefan T Engelter; Matthieu P Rutgers; Florian Hatz; Dimitrios Georgiadis; Felix Fluri; Lucka Sekoranja; Guido Schwegler; Felix M??ller; Bruno Weder; Hakan Sarikaya; Regina L??thy; Marcel Arnold; Krassen Nedeltchev; Marc Reichhart; Heinrich P Mattle; Barbara Tettenborn; Hansj??rg J Hungerb??hler; Roman Sztajzel; Ralf W Baumgartner; Patrik Michel; Philippe A Lyrer |
Publication Detail:
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Type: Comparative Study; Journal Article Date: 2009-10-15 |
Journal Detail:
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Title: Stroke; a journal of cerebral circulation Volume: 40 ISSN: 1524-4628 ISO Abbreviation: Stroke Publication Date: 2009 Dec |
Date Detail:
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Created Date: 2009-11-25 Completed Date: 2010-01-12 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0235266 Medline TA: Stroke Country: United States |
Other Details:
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Languages: eng Pagination: 3772-6 Citation Subset: IM |
Affiliation:
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Stroke Units and Department of Neurology, University Hospitals Basel, Switzerland. sengelter@uhbs.ch |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Carotid Artery Diseases / complications*, mortality Carotid Artery, Internal Databases, Factual Female Humans Injections, Intravenous Male Middle Aged Stroke / drug therapy*, etiology*, mortality Thrombolytic Therapy / adverse effects, methods* Treatment Outcome Vertebral Artery Dissection / complications*, mortality |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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