Thrombolysis in Cervical Artery Dissection – Data from the Cervical Artery Dissection and Ischaemic Stroke Patients (CADISP) database
European Journal of Neurology, 04/17/2012
Engelter ST et al. – As thrombolysis was neither independently associated with unfavourable outcome nor with an excess of symptomatic bleedings, the findings suggest thrombolysis should not be withheld in CeADStroke patients.Methods
- The authors 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.
- 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; P < 0.001) and more often occlusion of the dissected artery (66.2% vs. 39.4%; P < 0.001).
- After adjustment for stroke severity and vessel occlusion, the likelihood for favourable outcome did not differ between the treatment groups [ORadjusted 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)].