on October 15, 2009
Published online before print October 15, 2009, doi: 10.1161/STROKEAHA.109.555953
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Submitted on April 21, 2009
From the Stroke Units and Departments of Neurology, University Hospitals Basel (S.T.E., F.H., F.F., P.A.L.), Bern (M.A., K.N., H.P.M.), Geneva (L.S., R.S.), Lausanne (M.P.R., M.R., P.M.), and Zurich (D.G., H.S., R.W.B.), Cantonal Hospitals Aarau (G.S., H.J.H.), Thurgau (Muensterlingen; F.M.), St Gallen (B.W., B.T.), and the Department of Internal Medicine Triemli Hospital (Zurich; R.L.), Switzerland. * To whom correspondence should be addressed. E-mail: sengelter{at}uhbs.ch.
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 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). Conclusion—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.
Revised on August 12, 2009
Accepted on August 25, 2009
Intravenous Thrombolysis in Stroke Attributable to Cervical Artery Dissection
Stefan T. Engelter MD*;
1 at 3 months was considered favorable.
Key words: carotid artery • cervical artery dissection • complications • dissection • outcome • thrombolysis