Thrombolysis in Cervical Artery Dissection – Data from the Cervical Artery Dissection and Ischaemic Stroke Patients (CADISP) database |
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| Authors: | M. Kloss T. M. Metso D. Leys T. Brandt Y. Samson V. Caso A. Pezzini M. Sessa S. Beretta S. Debette C. Grond‐Ginsbach A. J. Metso V. Thijs C. Lamy E. Medeiros J. J. Martin A. Bersano T. Tatlisumak E. Touzé P. A. Lyrer for the Cervical Artery Dissection Ischaemic Stroke Patients ‐Study Group |
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| Affiliation: | 1. Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany;2. Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland;3. Department of Neurology, University Lille Nord de France, Lille, France;4. Clinics for Neurologic Rehabilitation, Kliniken Schmieder, Heidelberg, Germany;5. Department of Neurology, Pitié‐Salpêtrière University Hospital, Paris, France;6. Stroke Unit, Perugia University Hospital, Perugia, Italy;7. Department of Medical and Surgical Sciences, Neurology Clinic, University of Brescia, Brescia, Italy;8. Department of Neurology, San Raffaele University Hospital, Milan, Italy;9. Department of Neurology, Monza University Hospital, Monza, Italy;10. Department of Epidemiology and Public Health, Inserm U744, Pasteur Institute, Lille, France;11. Department of Neurology, Amiens University Hospital, Amiens, France;12. Department of Neurology, Besan?on University Hospital, Besancon, France;13. Department of Neurology, Sanatorio Allende, Cordoba, Argentina;14. Department of Neurology Ospedale Maggiore, Milan, Italy;15. Department of Neurology, Sainte‐Anne Hospital, Paris Descartes University, Paris, France;16. Department of Neurology, Basel University Hospital, Basel, Switzerland |
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| Abstract: | Objective: To examine whether thrombolysis for stroke attributable to cervical artery dissection (CeADStroke) affects outcome and major haemorrhage rates. Methods: We used a multicentre CeADStroke database to compare CeADStroke patients treated with and without thrombolysis. Main outcome measures were favourable 3‐month outcome (modified Rankin Scale 0–2) and ‘major haemorrhage’ [any intracranial haemorrhage (ICH) and major extracranial haemorrhage]. Adjusted odds ratios [OR (95% confidence intervals)] were calculated on the whole database and on propensity‐matched groups. Results: Among 616 CeADStroke patients, 68 (11.0%) received thrombolysis; which was used in 55 (81%) intravenously. Thrombolyzed patients had more severe strokes (median NIHSS score 16 vs. 3; P < 0.001) and more often occlusion of the dissected artery (66.2% vs. 39.4%; P < 0.001). After adjustment for stroke severity and vessel occlusion, the likelihood for favourable outcome did not differ between the treatment groups [ORadjusted 0.95 (95% CI 0.45–2.00)]. The propensity matching score model showed that the odds to recover favourably were virtually identical for 64 thrombolyzed and 64 non‐thrombolyzed‐matched CeADStroke patients [OR 1.00 (0.49–2.00)]. Haemorrhages occurred in 4 (5.9%) thrombolyzed patients, all being asymptomatic ICHs. In the non‐thrombolysis group, 3 (0.6%) patients had major haemorrhages [asymptomatic ICH (n = 2) and major extracranial haemorrhage (n = 1)]. Conclusion: As thrombolysis was neither independently associated with unfavourable outcome nor with an excess of symptomatic bleedings, our findings suggest thrombolysis should not be withheld in CeADStroke patients. However, the lack of any trend towards a benefit of thrombolysis may indicate the legitimacy to search for more efficient treatment options including mechanical revascularization strategies. |
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| Keywords: | cervical artery dissection complications ischaemic stroke outcome thrombolysis |
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