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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.

Abstract
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.
AuthorsGeorgios Tsivgoulis, Ramin Zand, Aristeidis H Katsanos, Vijay K Sharma, Nitin Goyal, Christos Krogias, Apostolos Safouris, Konstantinos Vadikolias, Konstantinos Voumvourakis, Anne W Alexandrov, Marc D Malkoff, Andrei V Alexandrov
JournalJournal of neurology (J Neurol) Vol. 262 Issue 9 Pg. 2135-43 (Sep 2015) ISSN: 1432-1459 [Electronic] Germany
PMID26108410 (Publication Type: Journal Article, Meta-Analysis, Multicenter Study, Research Support, Non-U.S. Gov't)
Chemical References
  • Fibrinolytic Agents
  • Tissue Plasminogen Activator
Topics
  • Adult
  • Aged
  • Aortic Dissection (complications)
  • Brain Ischemia (drug therapy, etiology)
  • Female
  • Fibrinolytic Agents (adverse effects, therapeutic use)
  • Humans
  • Male
  • Middle Aged
  • Stroke (drug therapy, etiology)
  • Thrombolytic Therapy (adverse effects)
  • Tissue Plasminogen Activator (adverse effects, therapeutic use)
  • Treatment Outcome

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