Thrombolysis in Cervical Artery Dissection - Data from the Cervical Artery Dissection and Ischaemic Stroke Patients (CADISP) database

S. T. Engelter, J. Dallongeville, 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. TatlisumakE. Touzé, P. A. Lyrer

Research output: Contribution to journalArticle

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; Padjusted 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.

Original languageEnglish
Pages (from-to)1199-1206
Number of pages8
JournalEuropean Journal of Neurology
Volume19
Issue number9
DOIs
Publication statusPublished - Sep 2012

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Keywords

  • Cervical artery dissection
  • Complications
  • Ischaemic stroke
  • Outcome
  • Thrombolysis

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology

Cite this

Engelter, S. T., Dallongeville, J., Kloss, M., Metso, T. M., Leys, D., Brandt, T., Samson, Y., Caso, V., Pezzini, A., Sessa, M., Beretta, S., Debette, S., Grond-Ginsbach, C., Metso, A. J., Thijs, V., Lamy, C., Medeiros, E., Martin, J. J., Bersano, A., ... Lyrer, P. A. (2012). Thrombolysis in Cervical Artery Dissection - Data from the Cervical Artery Dissection and Ischaemic Stroke Patients (CADISP) database. European Journal of Neurology, 19(9), 1199-1206. https://doi.org/10.1111/j.1468-1331.2012.03704.x