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Safety and outcomes of intravenous thrombolysis in dissection-related ischemic stroke: an international multicenter study and comprehensive meta-analysis of reported case series

Tsivgoulis, Georgios
Author Tsivgoulis, Georgios Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA. tsivgoulisgiorg@yahoo.gr Second Department of Neurology, "Attikon University Hospital", School of Medicine, University of Athens, Iras 39, Gerakas Attikis, 15344, Athens, Greece. tsivgoulisgiorg@yahoo.gr Department of Neurology, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece. tsivgoulisgiorg@yahoo.gr International Clinical Research Center, St. Anne's University Hospital in Brno, Brno, Czech Republic. tsivgoulisgiorg@yahoo.gr
Zand, Ramin
Author Zand, Ramin Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA
Katsanos, Aristeidis H
Author Katsanos, Aristeidis H Second Department of Neurology, "Attikon University Hospital", School of Medicine, University of Athens, Iras 39, Gerakas Attikis, 15344, Athens, Greece
Sharma, Vijay K
Author Sharma, Vijay K Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore
Goyal, Nitin
Author Goyal, Nitin Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA
Krogias, Christos
Author Krogias, Christos Department of Neurology, St. Josef-Hospital, Ruhr University, Bochum, Germany
Safouris, Apostolos
Author Safouris, Apostolos Stroke Unit, Department of Neurology, Brugmann University Hospital, Brussels, Belgium
Vadikolias, Konstantinos
Author Vadikolias, Konstantinos Department of Neurology, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece
Voumvourakis, Konstantinos
Author Voumvourakis, Konstantinos Second Department of Neurology, "Attikon University Hospital", School of Medicine, University of Athens, Iras 39, Gerakas Attikis, 15344, Athens, Greece
Alexandrov, Anne W
Author Alexandrov, Anne W Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA Australian Catholic University, Sydney, Australia
Malkoff, Marc D
Author Malkoff, Marc D Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA
Alexandrov, Andrei V
Author Alexandrov, Andrei V Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA

Journal of neurology. 2015 Sep ; 262 (9) : 2135-43. [epub] 20150625

J Neurol
ISSN 1432-1459 | 0340-5354
Source

Language English Country Germany Media print-electronic

Document type Journal Article, Meta-Analysis, Multicenter Study, Research Support, Non-U.S. Gov't

Persistent link https://www.medvik.cz/link/pmid26108410

PubMed 26108410
DOI 10.1007/s00415-015-7829-x
PII: 10.1007/s00415-015-7829-x
Knihovny.cz E-resources

Keywords
Carotid artery dissection, Cervical artery dissection, Dissection-related ischemic stroke, Symptomatic intracranial hemorrhage, Thrombolysis, Tissue plasminogen activator, Vertebral artery dissection,
MeSH
Stroke drug therapy etiology MeSH
Aortic Dissection complications MeSH
Adult MeSH
Fibrinolytic Agents adverse effects therapeutic use MeSH
Brain Ischemia drug therapy etiology MeSH
Middle Aged MeSH
Humans MeSH
Aged MeSH
Tissue Plasminogen Activator adverse effects therapeutic use MeSH
Thrombolytic Therapy adverse effects MeSH
Treatment Outcome MeSH
Check Tag
Adult MeSH
Middle Aged MeSH
Humans MeSH
Male MeSH
Aged MeSH
Female MeSH
Publication type
Journal Article MeSH
Meta-Analysis MeSH
Multicenter Study MeSH
Research Support, Non-U.S. Gov't MeSH
Names of Substances
Fibrinolytic Agents MeSH
Tissue Plasminogen Activator MeSH

The safety and efficacy of intravenous thrombolysis (IVT) in dissection-related ischemic stroke (DRIS) has not been established. We sought to determine safety and recovery rates of IVT in DRIS using prospective, international, multicenter data and by conducting a comprehensive meta-analysis of reported case series. We analyzed consecutive DRIS patients treated with IVT according to national guidelines during a 5-year period at six tertiary-care stroke centers, and also conducted a comprehensive review and meta-analysis of all available case series reporting safety outcomes in DRIS treated with IVT according to PRISMA guidelines. A total of 39 DRIS patients (mean age 60 ± 18 years; 59% men; median NIHSS 13 points, IQR 9-17) received IVT in our multicenter study. Symptomatic intracranial hemorrhage (sICH), in-hospital mortality, complete recanalization, favorable functional outcome (FFO; mRS-score of 0-1) and functional independence (FI; mRS-score of 0-2) were 0% (adjusted Wald 95% CI 0-8%), 10% (3-24%), 55% (40-70%), 61% (45-74%) and 68% (52-81%). The pooled sICH and mortality rates in meta-analysis including 10 case series (234 IVT-DRIS patients) were 2% (0-5%) and 4% (0-8%). The pooled recanalization, FFO and FI rates were 45% (26-67%), 41% (29-54%) and 61% (48-72%), respectively. Substantial heterogeneity was only found for FFO (I(2) = 61%; p = 0.006). Subsequent meta-regression analysis identified baseline NIHSS and dissection in the posterior circulation as independent predictors of FFO (p < 0.05), accounting for FFO variance across different studies. Our prospective, international data coupled with comprehensive meta-analysis results underscore IVT safety in DRIS, while further independent validation is required in larger observational registries or RCTs.

2nd Department of Neurology Attikon University Hospital School of Medicine University of Athens Iras 39 Gerakas Attikis 15344 Athens Greece

Australian Catholic University Sydney Australia

Department of Neurology School of Medicine Democritus University of Thrace Alexandroupolis Greece

Department of Neurology St Josef Hospital Ruhr University Bochum Germany

Department of Neurology University of Tennessee Health Science Center Memphis TN USA

Division of Neurology Department of Medicine National University Hospital Singapore Singapore

International Clinical Research Center St Anne's University Hospital in Brno Brno Czech Republic

Stroke Unit Department of Neurology Brugmann University Hospital Brussels Belgium

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