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 language | English |
|---|---|
| Pages (from-to) | 1199-1206 |
| Number of pages | 8 |
| Journal | European Journal of Neurology |
| Volume | 19 |
| Issue number | 9 |
| DOIs | |
| Publication status | Published - Sep 2012 |
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Keywords
- Cervical artery dissection
- Complications
- Ischaemic stroke
- Outcome
- Thrombolysis
ASJC Scopus subject areas
- Clinical Neurology
- Neurology
Cite this
Thrombolysis in Cervical Artery Dissection - Data from the Cervical Artery Dissection and Ischaemic Stroke Patients (CADISP) database. / 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.; Tatlisumak, T.; Touzé, E.; Lyrer, P. A.
In: European Journal of Neurology, Vol. 19, No. 9, 09.2012, p. 1199-1206.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Thrombolysis in Cervical Artery Dissection - Data from the Cervical Artery Dissection and Ischaemic Stroke Patients (CADISP) database
AU - Engelter, S. T.
AU - Dallongeville, J.
AU - Kloss, M.
AU - Metso, T. M.
AU - Leys, D.
AU - Brandt, T.
AU - Samson, Y.
AU - Caso, V.
AU - Pezzini, A.
AU - Sessa, M.
AU - Beretta, S.
AU - Debette, S.
AU - Grond-Ginsbach, C.
AU - Metso, A. J.
AU - Thijs, V.
AU - Lamy, C.
AU - Medeiros, E.
AU - Martin, J. J.
AU - Bersano, A.
AU - Tatlisumak, T.
AU - Touzé, E.
AU - Lyrer, P. A.
PY - 2012/9
Y1 - 2012/9
N2 - 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.
AB - 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.
KW - Cervical artery dissection
KW - Complications
KW - Ischaemic stroke
KW - Outcome
KW - Thrombolysis
UR - http://www.scopus.com/inward/record.url?scp=84865280085&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84865280085&partnerID=8YFLogxK
U2 - 10.1111/j.1468-1331.2012.03704.x
DO - 10.1111/j.1468-1331.2012.03704.x
M3 - Article
C2 - 22448957
AN - SCOPUS:84865280085
VL - 19
SP - 1199
EP - 1206
JO - European Journal of Neurology
JF - European Journal of Neurology
SN - 1351-5101
IS - 9
ER -