Document Detail

Stent-assisted endovascular thrombolysis versus intravenous thrombolysis in internal carotid artery dissection with tandem internal carotid and middle cerebral artery occlusion.
MedLine Citation:
PMID:  17600235     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND PURPOSE: Tandem internal carotid and middle cerebral artery occlusion independently predicts poor outcome after intravenous thrombolysis. Recanalization of internal carotid artery dissection by stent-assisted angioplasty has recently been proposed when anticoagulation fails to prevent a new ischemic event. We recently reported a case of tandem internal carotid and middle cerebral artery occlusion with dissection of the internal carotid artery successfully treated with endovascular stent-assisted thrombolysis. METHODS: We compared clinical outcomes in consecutive patients presenting with tandem internal carotid and middle cerebral artery occlusion with internal carotid artery dissection within 3 hours of symptom onset who were eligible for intravenous thrombolysis, treated by either endovascular stent-assisted thrombolysis or intravenous recombinant tissue-type plasminogen activator (rtPA) when an endovascular therapist was unavailable. National Institutes of Health Stroke Scale scores were obtained at baseline and after 24 hours. The modified Rankin Scale score was used to assess outcomes at 3 months. Arterial recanalization was assessed by magnetic resonance imaging. RESULTS: Of 10 patients screened, 6 were treated with endovascular therapy and 4 with intravenous rtPA. Before treatment, mean National Institutes of Health Stroke Scale scores were high and comparable in the 2 groups (17 and 16, respectively). In the endovascular group, all patients achieved middle cerebral artery recanalization with subsequent dramatic improvement versus only 1 patient with middle cerebral artery recanalization in the intravenous rtPA group. At 3 months, 4 patients in the endovascular group had a favorable outcome (modified Rankin Scale score=0). In the intravenous rtPA group, 3 patients had a poor outcome (modified Rankin Scale score> or =3). CONCLUSIONS: Endovascular stent-assisted thrombolysis is a promising treatment in tandem internal carotid and middle cerebral artery occlusion due to internal carotid artery dissection and compares favorably with intravenous rtPA.
Philippa C Lavallée; Mickaël Mazighi; Jean-Pierre Saint-Maurice; Elena Meseguer; Halim Abboud; Isabelle F Klein; Emmanuel Houdart; Pierre Amarenco
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't     Date:  2007-06-28
Journal Detail:
Title:  Stroke; a journal of cerebral circulation     Volume:  38     ISSN:  1524-4628     ISO Abbreviation:  Stroke     Publication Date:  2007 Aug 
Date Detail:
Created Date:  2007-07-31     Completed Date:  2007-08-29     Revised Date:  2008-02-20    
Medline Journal Info:
Nlm Unique ID:  0235266     Medline TA:  Stroke     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2270-4     Citation Subset:  IM    
Department of Neurology and Stroke Centre, Bichat University Hospital and Medical School, Paris, France.
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MeSH Terms
Angioplasty / standards,  statistics & numerical data
Carotid Artery Thrombosis / therapy*
Carotid Artery, Internal / pathology,  physiopathology
Carotid Artery, Internal, Dissection / therapy*
Infarction, Middle Cerebral Artery / therapy*
Injections, Intravenous
Magnetic Resonance Angiography
Magnetic Resonance Imaging
Middle Aged
Middle Cerebral Artery / pathology,  physiopathology
Thrombolytic Therapy / instrumentation,  methods*
Tissue Plasminogen Activator / administration & dosage*
Treatment Outcome
Reg. No./Substance:
EC Plasminogen Activator
Comment In:
Stroke. 2008 Feb;39(2):e27-8   [PMID:  18162619 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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