Intravenous thrombolysis for acute ischemic stroke associated to extracranial internal carotid artery occlusion: The ICARO-2 study

Maurizio Paciaroni, Giancarlo Agnelli, Valeria Caso, Alessio Pieroni, Paolo Bovi, Manuel Cappellari, Andrea Zini, Paolo Nichelli, Domenico Inzitari, Mascia Nesi, Patrizia Nencini, Alessandro Pezzini, Alessandro Padovani, Tiziana Tassinari, Giovanni Orlandi, Alberto Chiti, Gino Gialdini, Andrea Alberti, Michele Venti, Monica AcciarresiCataldo D'amore, Emilio Luda, Rossana Tassi, Giuseppe Martini, Carlo Ferrarese, Simone Beretta, Claudia Trentini, Giorgio Silvestrelli, Alessia Lanari, Paolo Previdi, Alfonso Ciccone, Maria Luisa Delodovici, Giorgio Bono, Giampiero Galletti, Simona Marcheselli, Massimo Del Sette, Elisabetta Traverso, Maurizio Riva, Mauro Silvestrini, Raffaella Cerqua, Domenico Consoli, Serena Monaco, Danilo Toni

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Background and Purposes: In a case-control study in patients with acute ischemic stroke and extracranial internal carotid artery (eICA) occlusion, thrombolytic treatment was associated with increased mortality. The aim of this cohort study was to assess the efficacy and safety of thrombolysis in patients with eICA occlusion compared to those without eICA occlusion. Methods: Consecutive patients treated with intravenous tissue-type plasminogen activator within 4.5 h from symptom onset included in the Safe Implementation of Thrombolysis in Stroke - International Stroke Thrombolysis Registry (SITS-ISTR) in 20 Italian centres were analyzed. Acute carotid occlusion was diagnosed using ultrasound examination, angio-CT scan or angio-MRI. Since the SITS-ISTR database did not plan to report the site of vessel occlusion, each participating center provided the code of the patient with eICA occlusion. Patients were divided into 2 groups, those with and those without eICA occlusion. Main outcome measures were: death, disability (modified Rankin Scale, mRS, 3-6) and any intracranial bleeding at 3 months. Multiple logistic regression analysis was performed to reveal predictors for main outcomes. The following variables of interest were included in the analysis: presence of eICA occlusion, age, gender, diabetes mellitus, hyperlipidemia, atrial fibrillation, congestive heart failure, previous stroke, current smoking, antiplatelet treatment at stroke onset, baseline NIHSS score, baseline blood glucose, cholesterol and blood pressure, history of hypertension and stroke onset to treatment time. Results: A total of 1,761 patients without eICA occlusion and 137 with eICA occlusion were included in the study. At 3 months, 42 patients were lost to follow-up (3 with eICA occlusion). Death occurred in 30 (22.4%) patients with eICA occlusion and in 175 (10.2%) patients without (p <0.0001). Death or disability at 3 months occurred in 91 of 134 patients with eICA occlusion (67.9%) compared with 654 of 1,722 patients without eICA occlusion (37.9%, p <0.0001). No or minimal disability at 3 months (mRS 0-1) was reported in 25 (18.7%) patients with eICA occlusion and in 829 (48.2%) patients without (p <0.0001). Any intracranial bleeding detected by CT or MRI at posttreatment imaging was seen in 16 (11.7%) patients with eICA occlusion and in 314 (17.8%) of those without (p = 0.09). The proportion of symptomatic intracerebral hemorrhage was 5.8% for patients with eICA occlusion and 8.0% for patients without (p = 0.16). At logistic regression analysis, eICA occlusion was associated with mortality (odds ratio, OR 5.7; 95% confidence interval, CI 2.9-11.1) and mortality or disability (OR 5.0; 95% CI 2.9-8.7) at 90 days. Conclusions: This cohort study in patients with acute ischemic stroke treated with thrombolysis showed an association between eICA occlusion and adverse outcome.

Original languageEnglish
Pages (from-to)430-435
Number of pages6
JournalCerebrovascular Diseases
Volume34
Issue number5-6
DOIs
Publication statusPublished - Dec 2012

Fingerprint

Internal Carotid Artery
Stroke
Registries
Mortality
Cohort Studies
Logistic Models
Regression Analysis
Hemorrhage
Lost to Follow-Up
Cerebral Hemorrhage
Tissue Plasminogen Activator
Hyperlipidemias
Atrial Fibrillation

Keywords

  • Acute stroke
  • Carotid occlusion
  • Outcome
  • Systemic thrombolysis

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology
  • Cardiology and Cardiovascular Medicine

Cite this

Intravenous thrombolysis for acute ischemic stroke associated to extracranial internal carotid artery occlusion : The ICARO-2 study. / Paciaroni, Maurizio; Agnelli, Giancarlo; Caso, Valeria; Pieroni, Alessio; Bovi, Paolo; Cappellari, Manuel; Zini, Andrea; Nichelli, Paolo; Inzitari, Domenico; Nesi, Mascia; Nencini, Patrizia; Pezzini, Alessandro; Padovani, Alessandro; Tassinari, Tiziana; Orlandi, Giovanni; Chiti, Alberto; Gialdini, Gino; Alberti, Andrea; Venti, Michele; Acciarresi, Monica; D'amore, Cataldo; Luda, Emilio; Tassi, Rossana; Martini, Giuseppe; Ferrarese, Carlo; Beretta, Simone; Trentini, Claudia; Silvestrelli, Giorgio; Lanari, Alessia; Previdi, Paolo; Ciccone, Alfonso; Delodovici, Maria Luisa; Bono, Giorgio; Galletti, Giampiero; Marcheselli, Simona; Del Sette, Massimo; Traverso, Elisabetta; Riva, Maurizio; Silvestrini, Mauro; Cerqua, Raffaella; Consoli, Domenico; Monaco, Serena; Toni, Danilo.

In: Cerebrovascular Diseases, Vol. 34, No. 5-6, 12.2012, p. 430-435.

Research output: Contribution to journalArticle

Paciaroni, M, Agnelli, G, Caso, V, Pieroni, A, Bovi, P, Cappellari, M, Zini, A, Nichelli, P, Inzitari, D, Nesi, M, Nencini, P, Pezzini, A, Padovani, A, Tassinari, T, Orlandi, G, Chiti, A, Gialdini, G, Alberti, A, Venti, M, Acciarresi, M, D'amore, C, Luda, E, Tassi, R, Martini, G, Ferrarese, C, Beretta, S, Trentini, C, Silvestrelli, G, Lanari, A, Previdi, P, Ciccone, A, Delodovici, ML, Bono, G, Galletti, G, Marcheselli, S, Del Sette, M, Traverso, E, Riva, M, Silvestrini, M, Cerqua, R, Consoli, D, Monaco, S & Toni, D 2012, 'Intravenous thrombolysis for acute ischemic stroke associated to extracranial internal carotid artery occlusion: The ICARO-2 study', Cerebrovascular Diseases, vol. 34, no. 5-6, pp. 430-435. https://doi.org/10.1159/000345081
Paciaroni, Maurizio ; Agnelli, Giancarlo ; Caso, Valeria ; Pieroni, Alessio ; Bovi, Paolo ; Cappellari, Manuel ; Zini, Andrea ; Nichelli, Paolo ; Inzitari, Domenico ; Nesi, Mascia ; Nencini, Patrizia ; Pezzini, Alessandro ; Padovani, Alessandro ; Tassinari, Tiziana ; Orlandi, Giovanni ; Chiti, Alberto ; Gialdini, Gino ; Alberti, Andrea ; Venti, Michele ; Acciarresi, Monica ; D'amore, Cataldo ; Luda, Emilio ; Tassi, Rossana ; Martini, Giuseppe ; Ferrarese, Carlo ; Beretta, Simone ; Trentini, Claudia ; Silvestrelli, Giorgio ; Lanari, Alessia ; Previdi, Paolo ; Ciccone, Alfonso ; Delodovici, Maria Luisa ; Bono, Giorgio ; Galletti, Giampiero ; Marcheselli, Simona ; Del Sette, Massimo ; Traverso, Elisabetta ; Riva, Maurizio ; Silvestrini, Mauro ; Cerqua, Raffaella ; Consoli, Domenico ; Monaco, Serena ; Toni, Danilo. / Intravenous thrombolysis for acute ischemic stroke associated to extracranial internal carotid artery occlusion : The ICARO-2 study. In: Cerebrovascular Diseases. 2012 ; Vol. 34, No. 5-6. pp. 430-435.
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title = "Intravenous thrombolysis for acute ischemic stroke associated to extracranial internal carotid artery occlusion: The ICARO-2 study",
abstract = "Background and Purposes: In a case-control study in patients with acute ischemic stroke and extracranial internal carotid artery (eICA) occlusion, thrombolytic treatment was associated with increased mortality. The aim of this cohort study was to assess the efficacy and safety of thrombolysis in patients with eICA occlusion compared to those without eICA occlusion. Methods: Consecutive patients treated with intravenous tissue-type plasminogen activator within 4.5 h from symptom onset included in the Safe Implementation of Thrombolysis in Stroke - International Stroke Thrombolysis Registry (SITS-ISTR) in 20 Italian centres were analyzed. Acute carotid occlusion was diagnosed using ultrasound examination, angio-CT scan or angio-MRI. Since the SITS-ISTR database did not plan to report the site of vessel occlusion, each participating center provided the code of the patient with eICA occlusion. Patients were divided into 2 groups, those with and those without eICA occlusion. Main outcome measures were: death, disability (modified Rankin Scale, mRS, 3-6) and any intracranial bleeding at 3 months. Multiple logistic regression analysis was performed to reveal predictors for main outcomes. The following variables of interest were included in the analysis: presence of eICA occlusion, age, gender, diabetes mellitus, hyperlipidemia, atrial fibrillation, congestive heart failure, previous stroke, current smoking, antiplatelet treatment at stroke onset, baseline NIHSS score, baseline blood glucose, cholesterol and blood pressure, history of hypertension and stroke onset to treatment time. Results: A total of 1,761 patients without eICA occlusion and 137 with eICA occlusion were included in the study. At 3 months, 42 patients were lost to follow-up (3 with eICA occlusion). Death occurred in 30 (22.4{\%}) patients with eICA occlusion and in 175 (10.2{\%}) patients without (p <0.0001). Death or disability at 3 months occurred in 91 of 134 patients with eICA occlusion (67.9{\%}) compared with 654 of 1,722 patients without eICA occlusion (37.9{\%}, p <0.0001). No or minimal disability at 3 months (mRS 0-1) was reported in 25 (18.7{\%}) patients with eICA occlusion and in 829 (48.2{\%}) patients without (p <0.0001). Any intracranial bleeding detected by CT or MRI at posttreatment imaging was seen in 16 (11.7{\%}) patients with eICA occlusion and in 314 (17.8{\%}) of those without (p = 0.09). The proportion of symptomatic intracerebral hemorrhage was 5.8{\%} for patients with eICA occlusion and 8.0{\%} for patients without (p = 0.16). At logistic regression analysis, eICA occlusion was associated with mortality (odds ratio, OR 5.7; 95{\%} confidence interval, CI 2.9-11.1) and mortality or disability (OR 5.0; 95{\%} CI 2.9-8.7) at 90 days. Conclusions: This cohort study in patients with acute ischemic stroke treated with thrombolysis showed an association between eICA occlusion and adverse outcome.",
keywords = "Acute stroke, Carotid occlusion, Outcome, Systemic thrombolysis",
author = "Maurizio Paciaroni and Giancarlo Agnelli and Valeria Caso and Alessio Pieroni and Paolo Bovi and Manuel Cappellari and Andrea Zini and Paolo Nichelli and Domenico Inzitari and Mascia Nesi and Patrizia Nencini and Alessandro Pezzini and Alessandro Padovani and Tiziana Tassinari and Giovanni Orlandi and Alberto Chiti and Gino Gialdini and Andrea Alberti and Michele Venti and Monica Acciarresi and Cataldo D'amore and Emilio Luda and Rossana Tassi and Giuseppe Martini and Carlo Ferrarese and Simone Beretta and Claudia Trentini and Giorgio Silvestrelli and Alessia Lanari and Paolo Previdi and Alfonso Ciccone and Delodovici, {Maria Luisa} and Giorgio Bono and Giampiero Galletti and Simona Marcheselli and {Del Sette}, Massimo and Elisabetta Traverso and Maurizio Riva and Mauro Silvestrini and Raffaella Cerqua and Domenico Consoli and Serena Monaco and Danilo Toni",
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doi = "10.1159/000345081",
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journal = "Cerebrovascular Diseases",
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TY - JOUR

T1 - Intravenous thrombolysis for acute ischemic stroke associated to extracranial internal carotid artery occlusion

T2 - The ICARO-2 study

AU - Paciaroni, Maurizio

AU - Agnelli, Giancarlo

AU - Caso, Valeria

AU - Pieroni, Alessio

AU - Bovi, Paolo

AU - Cappellari, Manuel

AU - Zini, Andrea

AU - Nichelli, Paolo

AU - Inzitari, Domenico

AU - Nesi, Mascia

AU - Nencini, Patrizia

AU - Pezzini, Alessandro

AU - Padovani, Alessandro

AU - Tassinari, Tiziana

AU - Orlandi, Giovanni

AU - Chiti, Alberto

AU - Gialdini, Gino

AU - Alberti, Andrea

AU - Venti, Michele

AU - Acciarresi, Monica

AU - D'amore, Cataldo

AU - Luda, Emilio

AU - Tassi, Rossana

AU - Martini, Giuseppe

AU - Ferrarese, Carlo

AU - Beretta, Simone

AU - Trentini, Claudia

AU - Silvestrelli, Giorgio

AU - Lanari, Alessia

AU - Previdi, Paolo

AU - Ciccone, Alfonso

AU - Delodovici, Maria Luisa

AU - Bono, Giorgio

AU - Galletti, Giampiero

AU - Marcheselli, Simona

AU - Del Sette, Massimo

AU - Traverso, Elisabetta

AU - Riva, Maurizio

AU - Silvestrini, Mauro

AU - Cerqua, Raffaella

AU - Consoli, Domenico

AU - Monaco, Serena

AU - Toni, Danilo

PY - 2012/12

Y1 - 2012/12

N2 - Background and Purposes: In a case-control study in patients with acute ischemic stroke and extracranial internal carotid artery (eICA) occlusion, thrombolytic treatment was associated with increased mortality. The aim of this cohort study was to assess the efficacy and safety of thrombolysis in patients with eICA occlusion compared to those without eICA occlusion. Methods: Consecutive patients treated with intravenous tissue-type plasminogen activator within 4.5 h from symptom onset included in the Safe Implementation of Thrombolysis in Stroke - International Stroke Thrombolysis Registry (SITS-ISTR) in 20 Italian centres were analyzed. Acute carotid occlusion was diagnosed using ultrasound examination, angio-CT scan or angio-MRI. Since the SITS-ISTR database did not plan to report the site of vessel occlusion, each participating center provided the code of the patient with eICA occlusion. Patients were divided into 2 groups, those with and those without eICA occlusion. Main outcome measures were: death, disability (modified Rankin Scale, mRS, 3-6) and any intracranial bleeding at 3 months. Multiple logistic regression analysis was performed to reveal predictors for main outcomes. The following variables of interest were included in the analysis: presence of eICA occlusion, age, gender, diabetes mellitus, hyperlipidemia, atrial fibrillation, congestive heart failure, previous stroke, current smoking, antiplatelet treatment at stroke onset, baseline NIHSS score, baseline blood glucose, cholesterol and blood pressure, history of hypertension and stroke onset to treatment time. Results: A total of 1,761 patients without eICA occlusion and 137 with eICA occlusion were included in the study. At 3 months, 42 patients were lost to follow-up (3 with eICA occlusion). Death occurred in 30 (22.4%) patients with eICA occlusion and in 175 (10.2%) patients without (p <0.0001). Death or disability at 3 months occurred in 91 of 134 patients with eICA occlusion (67.9%) compared with 654 of 1,722 patients without eICA occlusion (37.9%, p <0.0001). No or minimal disability at 3 months (mRS 0-1) was reported in 25 (18.7%) patients with eICA occlusion and in 829 (48.2%) patients without (p <0.0001). Any intracranial bleeding detected by CT or MRI at posttreatment imaging was seen in 16 (11.7%) patients with eICA occlusion and in 314 (17.8%) of those without (p = 0.09). The proportion of symptomatic intracerebral hemorrhage was 5.8% for patients with eICA occlusion and 8.0% for patients without (p = 0.16). At logistic regression analysis, eICA occlusion was associated with mortality (odds ratio, OR 5.7; 95% confidence interval, CI 2.9-11.1) and mortality or disability (OR 5.0; 95% CI 2.9-8.7) at 90 days. Conclusions: This cohort study in patients with acute ischemic stroke treated with thrombolysis showed an association between eICA occlusion and adverse outcome.

AB - Background and Purposes: In a case-control study in patients with acute ischemic stroke and extracranial internal carotid artery (eICA) occlusion, thrombolytic treatment was associated with increased mortality. The aim of this cohort study was to assess the efficacy and safety of thrombolysis in patients with eICA occlusion compared to those without eICA occlusion. Methods: Consecutive patients treated with intravenous tissue-type plasminogen activator within 4.5 h from symptom onset included in the Safe Implementation of Thrombolysis in Stroke - International Stroke Thrombolysis Registry (SITS-ISTR) in 20 Italian centres were analyzed. Acute carotid occlusion was diagnosed using ultrasound examination, angio-CT scan or angio-MRI. Since the SITS-ISTR database did not plan to report the site of vessel occlusion, each participating center provided the code of the patient with eICA occlusion. Patients were divided into 2 groups, those with and those without eICA occlusion. Main outcome measures were: death, disability (modified Rankin Scale, mRS, 3-6) and any intracranial bleeding at 3 months. Multiple logistic regression analysis was performed to reveal predictors for main outcomes. The following variables of interest were included in the analysis: presence of eICA occlusion, age, gender, diabetes mellitus, hyperlipidemia, atrial fibrillation, congestive heart failure, previous stroke, current smoking, antiplatelet treatment at stroke onset, baseline NIHSS score, baseline blood glucose, cholesterol and blood pressure, history of hypertension and stroke onset to treatment time. Results: A total of 1,761 patients without eICA occlusion and 137 with eICA occlusion were included in the study. At 3 months, 42 patients were lost to follow-up (3 with eICA occlusion). Death occurred in 30 (22.4%) patients with eICA occlusion and in 175 (10.2%) patients without (p <0.0001). Death or disability at 3 months occurred in 91 of 134 patients with eICA occlusion (67.9%) compared with 654 of 1,722 patients without eICA occlusion (37.9%, p <0.0001). No or minimal disability at 3 months (mRS 0-1) was reported in 25 (18.7%) patients with eICA occlusion and in 829 (48.2%) patients without (p <0.0001). Any intracranial bleeding detected by CT or MRI at posttreatment imaging was seen in 16 (11.7%) patients with eICA occlusion and in 314 (17.8%) of those without (p = 0.09). The proportion of symptomatic intracerebral hemorrhage was 5.8% for patients with eICA occlusion and 8.0% for patients without (p = 0.16). At logistic regression analysis, eICA occlusion was associated with mortality (odds ratio, OR 5.7; 95% confidence interval, CI 2.9-11.1) and mortality or disability (OR 5.0; 95% CI 2.9-8.7) at 90 days. Conclusions: This cohort study in patients with acute ischemic stroke treated with thrombolysis showed an association between eICA occlusion and adverse outcome.

KW - Acute stroke

KW - Carotid occlusion

KW - Outcome

KW - Systemic thrombolysis

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