Intravenous Thrombolysis in Patients With Cervical Artery Dissection: A Secondary Analysis of the STOP-CAD Study.
Humans
Female
Male
Middle Aged
Thrombolytic Therapy
/ methods
Adult
Retrospective Studies
Ischemic Stroke
/ drug therapy
Vertebral Artery Dissection
/ drug therapy
Fibrinolytic Agents
/ administration & dosage
Carotid Artery, Internal, Dissection
/ drug therapy
Administration, Intravenous
Tissue Plasminogen Activator
/ administration & dosage
Treatment Outcome
Intracranial Hemorrhages
/ chemically induced
Journal
Neurology
ISSN: 1526-632X
Titre abrégé: Neurology
Pays: United States
ID NLM: 0401060
Informations de publication
Date de publication:
08 Oct 2024
08 Oct 2024
Historique:
medline:
20
9
2024
pubmed:
20
9
2024
entrez:
19
9
2024
Statut:
ppublish
Résumé
Cervical artery dissection (CeAD) accounts for 25% of ischemic strokes in young adults. This study evaluated the benefits and harms of intravenous thrombolysis (IVT) in patients presenting with spontaneous CeAD and acute ischemic stroke symptoms. This analysis used data from the retrospective STOP-CAD study and included patients with spontaneous CeAD who presented within 1 day of acute ischemic stroke symptoms. Patients were dichotomized into those who received IVT and those managed without IVT. We assessed the association between IVT and 90-day functional independence (modified Rankin Scale scores 0-2) and the incidence of symptomatic intracranial hemorrhage (ICH, defined as ICH causing new or worsening neurologic symptoms within 72 hours after CeAD diagnosis). This study included 1,653 patients from the original STOP-CAD cohort of 4,023. The median age was 49 years, and 35.1% were women; 512 (31.0%) received IVT. IVT was associated with 90-day functional independence (adjusted odds ratio [aOR] = 1.67, 95% CI 1.23-2.28, In patients with spontaneous CeAD and suspected ischemic stroke, IVT improved functional outcomes, without increasing symptomatic ICH risk. These findings support current guideline recommendations to consider thrombolysis for otherwise eligible patients with CeAD. This study provides Class III evidence that IVT significantly increases the probability of 90-day functional independence in patients with CeAD.
Identifiants
pubmed: 39298709
doi: 10.1212/WNL.0000000000209843
doi:
Substances chimiques
Fibrinolytic Agents
0
Tissue Plasminogen Activator
EC 3.4.21.68
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM