Stroke following internal carotid artery occlusion — a contra‐indication for intravenous thrombolysis?

Rudolf, Jobst; Neveling, M.; Grond, Martin; Schmülling, Susanne; Stenzel, Christoph; Heiss, Wolf‐Dieter

doi:10.1046/j.1468-1331.1999.610051.x

Cited by 58 publications

(53 citation statements)

References 17 publications

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“…Only 36% of the IVT-treated patients with CAD did have a favorable outcome, that is, mRSՅ1 after 3 months, which is in line with results obtained in smaller series (2 of 6, 13 4 of 11, 12 and 12 of 33 11 ). The rate is slightly lower than that of the European Cooperative Acute Stroke Study (ECASS) (3-hour cohort; 40%), 8 and the National Institute of Neurological Diseases and Stroke trial 1 (39%), in which patients had comparable stroke severity to that of the current CAD cohort (median NIHSSϭ13, 8 14, 1 to 14 [our study]).…”

Section: Discussionsupporting

confidence: 87%

“…Only information of case series without control groups and small sample sizes (ie, 30, 11 11, 12 6, 13 and 2 14 is available, which suggests low complications rates of IVT for patients with CAD. [11][12][13][14] With these considerations in mind, we aimed at evaluating whether the variable "stroke etiology CAD" has a prognostic meaning in IVT-treated patients. Specifically, we analyzed and compared outcome and complications of CAD and non-CAD patients using pooled data of Swiss stroke centers.…”

mentioning

confidence: 99%

“…Treatment guidelines 10 do not advise against IVT in such patients, but randomized, placebo-controlled trial-based data about IVT versus placebo in patients with CAD are not available. Only information of case series without control groups and small sample sizes (ie, 30, 11 11,12 6, 13 and 2 14 is available, which suggests low complications rates of IVT for patients with CAD. [11][12][13][14] With these considerations in mind, we aimed at evaluating whether the variable "stroke etiology CAD" has a prognostic meaning in IVT-treated patients.…”

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confidence: 99%

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Intravenous Thrombolysis in Stroke Attributable to Cervical Artery Dissection

Engelter

Rutgers

Hatz

et al. 2009

Stroke

108

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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 Յ1 at 3 months was considered favorable. 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; Pϭ0.03). Intracranial cerebral hemorrhages (asymptomatic, symptomatic, fatal) were equally frequent in CAD (14% [7%, 7%, 2%]) and non-CAD patients (14% [9%, 5%, 2%]; Pϭ0.99). Recurrent ischemic stroke occurred in 1.8% of patients with CAD and in 3.7% of non-CAD-patients (Pϭ0.71). 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. Key Words: carotid artery Ⅲ cervical artery dissection Ⅲ complications Ⅲ dissection Ⅲ outcome Ⅲ thrombolysis I ntravenous thrombolysis (IVT) for acute ischemic stroke using recombinant tissue plasminogen activator has been shown to be safe and efficacious. 1,2 Treatment response seems to be independent of the underlying stroke mechanism. 3 However, whether this observation includes patients with strokes attributable to cervical artery dissection (CAD) has not been studied. CAD is characterized by intramural accumulation of blood. Theoretically, IVT might promote and increase the intramural bleeding in CAD and cause progressive hemodynamic worsening and infarct growth. In patients with stroke with aortic dissection extending to the cervical arteries, IVT might be dangerous as it is in patients with IVT for myocardial infarction. 4 -6 According to recent pilot data, the outcome of 7 IVT-treated patients with CAD tended to be worse than that of 7 patients with CAD not treated with IVT. 7 In turn, patients with CAD have not been excluded from randomized, placebo-controlled trials 1,8,9 of IVT in stroke. Treatment guidelines 10 do not advise against IVT in such patients, but randomized, placebo-controlled trial-based data about IVT versus placebo in patients with CAD are not available. Only information of case series without control groups and small sample sizes (ie, 30, 11 11, 12 6, 13 a...

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Section: Discussionsupporting

confidence: 87%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Intravenous Thrombolysis in Stroke Attributable to Cervical Artery Dissection

Engelter

Rutgers

Hatz

et al. 2009

Stroke

108

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“…Exposure of the basement membrane leads to platelet aggregation with thrombus formation. Thrombi can be clinically occult, extend and occlude the vessel, or embolize 9,10 .…”

Section: Fig 2 Angiogram Demonstrating Left Internal Carotid Artery mentioning

confidence: 99%

Thrombolytic therapy for acute extra-cranial artery dissection: report of two cases

Zaidat

Filho

Singh

et al. 2001

Arq. Neuro-Psiquiatr.

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-Extra-cranial arterial dissection accounts for 10% of strokes in young people. Information on safety of thrombolytic administration in this group is limited. The literature, however, does not favor use of thrombolytics for myocardial ischemia when peripheral arterial dissection coexists. Based on the clinical and radiological features, two patients who presented with acute stroke secondary to arterial dissection were considered for thrombolysis. One of them received intra-venous recombinant tissue plasminogen activator (rtPA), and the other patient received intra-arterial rtPA. There were no post thrombolysis complications. This report supports feasibility of administering thrombolytics in acute ischemic strokes resulting from extra-cranial arterial dissection. Future larger studies are necessary to determine the efficacy, safety and long-term outcome in this patient population.KEY WORDS: thrombolysis, stroke, dissection, internal carotid artery. Terapia trombolítica em dissecções arteriais cérvico-cefálicas agudas: relato de dois casosRESUMO -Dissecção arterial cérvico-cefálica corresponde a 10 % dos acidentes vasculares cerebrais (AVC) em jovens. Informação sobre a segurança da administração de trombolíticos neste grupo é limitada. A literatura médica, entretanto, não favorece o uso de trombolíticos em isquemia miocárdica na coexistência de dissecção arterial periférica. Baseado nas características clínicas e radiológicas, dois pacientes com AVC agudo secundário a dissecção arterial foram considerados para terapia trombolítica. Um deles recebeu rtPA intravenoso e o outro paciente recebeu rtPA intra-arterial. Não houve complicações pós-trombólise. Este relato suporta a possibilidade do tratamento destes pacientes com terapia trombolítica. Estudos maiores são necessários para determinar a eficácia, segurança e resultados a longo prazo nesta população de pacientes. PALAVRAS-CHAVE: trombólise, acidente vascular cerebral, dissecção, artéria carótida interna.

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“…Patients with ischemic stroke caused by sICAD were not excluded in any controlled, randomized IVT trial, which evaluated the effect of tissue plasminogen activator ( No new or worsened local signs, rupture of the dissected artery or SAH were observed (Derex et al 2000;Rudolf et al 1999). One patient deteriorated during IVT, possibly due to recurrent thromboembolism .…”

Section: Intravenous Thrombolysismentioning

confidence: 99%

Management of Spontaneous Dissection of the Cervical Carotid Artery

Baumgartner

2009

Surgical Management of Cerebrovascular Disease

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This manuscript reviews the management of patients with spontaneous dissection of the cervical internal carotid artery (sICAD). Recommendations are not based on controlled-randomized trials, but on case-control and observational, hospital-based studies, and case reports. Vascular risk factors seem to be as prevalent in patients with sICAD as in age-matched, healthy volunteers. Stroke prevention includes the treatment of vascular risk factors and the administration of oral aspirin, which may be as effective as anticoagulation. The few available data indicate that most patients with sICAD causing severe stenosis or occlusion, or an aneurysm can be treated conservatively. Patients with sICAD were not excluded in the intravenous controlled-randomized thrombolysis trials with tissue plasminogen activator, but were excluded in the intraarterial controlled-randomized thrombolysis trials. Taking the few published case series and reports on thrombolysis in patients with sICAD into consideration, intravenous thrombolysis may be beneficial, whereas it remains unclear whether intraarterial thrombolysis is useful. This manuscript reviews the management of patients with spontaneous dissection of the cervical internal carotid artery (sICAD). The first part will deal with stroke prevention, in particular the vascular risk factors, antithrombotic therapy, and the treatment of severe stenosis or occlusion, and dissecting aneurysm. The second part will discuss thrombolytic treatment of acute ischemic stroke due to sICAD. Management of Spontaneous Dissection of the Cervical Carotid Artery

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Stroke following internal carotid artery occlusion — a contra‐indication for intravenous thrombolysis?

Cited by 58 publications

References 17 publications

Intravenous Thrombolysis in Stroke Attributable to Cervical Artery Dissection

Intravenous Thrombolysis in Stroke Attributable to Cervical Artery Dissection

Thrombolytic therapy for acute extra-cranial artery dissection: report of two cases

Management of Spontaneous Dissection of the Cervical Carotid Artery

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