Safety and outcomes of intravenous thrombolysis in dissection-related ischemic stroke: an international multicenter study and comprehensive meta-analysis of reported case series
Jazyk angličtina Země Německo Médium print-electronic
Typ dokumentu časopisecké články, metaanalýza, multicentrická studie, práce podpořená grantem
PubMed
26108410
DOI
10.1007/s00415-015-7829-x
PII: 10.1007/s00415-015-7829-x
Knihovny.cz E-zdroje
- Klíčová slova
- Carotid artery dissection, Cervical artery dissection, Dissection-related ischemic stroke, Symptomatic intracranial hemorrhage, Thrombolysis, Tissue plasminogen activator, Vertebral artery dissection,
- MeSH
- cévní mozková příhoda farmakoterapie etiologie MeSH
- disekce aorty komplikace MeSH
- dospělí MeSH
- fibrinolytika škodlivé účinky terapeutické užití MeSH
- ischemie mozku farmakoterapie etiologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- senioři MeSH
- tkáňový aktivátor plazminogenu škodlivé účinky terapeutické užití MeSH
- trombolytická terapie škodlivé účinky MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- metaanalýza MeSH
- multicentrická studie MeSH
- práce podpořená grantem MeSH
- Názvy látek
- fibrinolytika MeSH
- tkáňový aktivátor plazminogenu 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.
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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