Document Detail


Systemic Thrombolysis in Patients With Acute Ischemic Stroke and Internal Carotid ARtery Occlusion: The ICARO Study.
MedLine Citation:
PMID:  22034003     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND AND PURPOSE: The beneficial effect of intravenous thrombolytic therapy in patients with acute ischemic stroke attributable to internal carotid artery (ICA) occlusion remains unclear. The aim of this study was to evaluate the efficacy and safety of intravenous recombinant tissue-type plasminogen activator in these patients.MethodsICARO was a case-control multicenter study on prospectively collected data. Patients with acute ischemic stroke and ICA occlusion treated with intravenous recombinant tissue-type plasminogen activator within 4.5 hours from symptom onset (cases) were compared to matched patients with acute stroke and ICA occlusion not treated with recombinant tissue-type plasminogen activator (controls). Cases and controls were matched for age, gender, and stroke severity. The efficacy outcome was disability at 90 days assessed by the modified Rankin Scale, dichotomized as favorable (score of 0-2) or unfavorable (score of 3-6). Safety outcomes were death and any intracranial bleeding.ResultsIncluded in the analysis were 253 cases and 253 controls. Seventy-three cases (28.9%) had a favorable outcome as compared with 52 controls (20.6%; adjusted odds ratio (OR), 1.80; 95% confidence interval [CI], 1.03-3.15; P=0.037). A total of 104 patients died, 65 cases (25.7%) and 39 controls (15.4%; adjusted OR, 2.28; 95% CI, 1.36-3.22; P=0.001). There were more fatal bleedings (2.8% versus 0.4%; OR, 7.17; 95% CI, 0.87-58.71; P=0.068) in the cases than in the controls.ConclusionsIn patients with stroke attributable to ICA occlusion, thrombolytic therapy results in a significant reduction in the proportion of patients dependent in activities of daily living. Increases in death and any intracranial bleeding were the trade-offs for this clinical benefit.
Authors:
Maurizio Paciaroni; Clotilde Balucani; Giancarlo Agnelli; Valeria Caso; Giorgio Silvestrelli; James C Grotta; Andrew M Demchuk; Sung-Il Sohn; Giovanni Orlandi; Didier Leys; Alessandro Pezzini; Andrei V Alexandrov; Mauro Silvestrini; Luisa Fofi; Kristian Barlinn; Domenico Inzitari; Carlo Ferrarese; Rossana Tassi; Georgios Tsivgoulis; Domenico Consoli; Antonio Baldi; Paolo Bovi; Emilio Luda; Giampiero Galletti; Paolo Invernizzi; Maria Luisa Delodovici; Francesco Corea; Massimo Del Sette; Serena Monaco; Simona Marcheselli; Andrea Alberti; Michele Venti; Monica Acciarresi; Cataldo D'Amore; Federica Macellari; Alessia Lanari; Paolo Previdi; Nicole R Gonzales; Renganayaki K Pandurengan; Farhaan S Vahidy; Melvin Sline; Simerpreet S Bal; Alberto Chiti; Gino Gialdini; Frederic Dumont; Charlotte Cordonnier; Stéphanie Debette; Alessandro Padovani; Raffaella Cerqua; Ulf Bodechtel; Jessica Kepplinger; Mascia Nesi; Patrizia Nencini; Simone Beretta; Claudia Trentini; Giuseppe Martini; Charitomeni Piperidou; Ioannis Heliopoulos; Sebastiano D'Anna; Manuel Cappellari; Edoardo Donati; Giorgio Bono; Elisabetta Traverso; Danilo Toni
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-10-27
Journal Detail:
Title:  Stroke; a journal of cerebral circulation     Volume:  -     ISSN:  1524-4628     ISO Abbreviation:  -     Publication Date:  2011 Oct 
Date Detail:
Created Date:  2011-10-28     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0235266     Medline TA:  Stroke     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
From the Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy (76); Comprehesive Stroke Center, University of Birmingham, Birmingham, AL (18); Department of Neurology, University of Perugia, Italy; Department of Neurology, The University of Texas Health Science Center at Houston, Houston, TX (68); Department of Neurology, Poma Hospital, Mantova, Italy (77); Calgary Stroke Program, Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada (42); Department of Neurology, Keimyung University School of Medicine, Daegu, South Korea (36); Clinica Neurologica, Azienda Ospedaliero-Universitaria, Pisa, Italy (34); Department of Neurology, University of Lille Nord de France, Lille, France (27); Dipartimento di Scienze Mediche e Chirurgiche, Clinica Neurologica, University of Brescia, Brescia, Italy (27); Neurological Clinic, Polytechnic University of Marche, Ancona, Italy (13); Department of Neurological Sciences, Sapienza University of Rome, Rome, Italy (29); Department of Neurology, Dresden University Stroke Center, Dresden, Germany (10); Department of Neurological and Psychiatric Sciences, University of Florence, Firenze, Italy (8); San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy (8); Stroke Unit, AOU Senese, Siena, Italy (11); Department of Neurology, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece (6); Stroke Unit, Iazzolino Hospital, Vibo Valentia, Italy (5); Stroke Unit, Ospedale di Portogruaro, Portogruaro, Venice, Italy (5); SSO Stroke Unit, DAI di Neuroscienze, Azienda Ospedaliera-Universitaria Integrata, Verona, Italy (12);Neurology, Rivoli Hospital, Torino, Italy (4); Morgagni-Pierantoni Hospital, Forlì, Italy (4); Poliambulanza Hospital, Brescia, Italy (3); Stroke Unit, Neurology, Insubria University, Varese, Italy (4); UO Gravi Cerebrolesioni, San Giovanni Battista Hospital, Foligno, Italy (2); Stroke Unit, Department of Neurology, Sant'Andrea Hospital, La Spezia, Italy (3); Stroke Unit, Ospedale Civico, Palermo, Italy (3); Stroke Unit, Humanitas Hospital, Milano, Italy (2); and IRCCS, San Raffaele, Rome, Italy.
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