Intravenous thrombolysis in acute ischemic stroke due to occlusion of internal carotid artery – A Serbian Experience with Thrombolysis in Ischemic Stroke (SETIS)

Abstract Objective The benefit of intravenous thrombolysis in patients with internal carotid artery (ICA) occlusion is still unclear. The aim of this study was to assess the influence on outcome of intravenous thrombolysis in patients with ICA occlusion comparing to those without it. Methods Data were from the national register of all acute ischemic stroke patients treated with intravenous thrombolysis in Serbia. Patients with nonlacunar anterior circulation infarction were included and were divided into two groups, those with and those without ICA occlusion. We compared the differences in demographic characteristics, risk factors, baseline NIHSS score, early neurological improvement, 3-month functional outcome, complications and death between these two groups. Results Among 521 included patients there were 13.4% with ICA occlusion. Group with ICA occlusion had more males (82.9% vs. 60.5%; p = 0.0008), and more severe stroke (baseline NIHSS score 15.3 vs. 13.6; p = 0.004). Excellent functional outcome (mRS 0–1) at 3 months was recorded in 32.9% patients with ICA occlusion and in 50.6% patients without ( p = 0.009), while favorable functional outcome (mRS 0–2) was recorded in 50.0% of patients with ICA occlusion vs. 60.1% without ( p = 0.14). Death occurred in 12.9% patients with ICA occlusion and in 17.3% patients without it ( p = 0.40). There was no significant difference in rate of symptomatic ICH between the two groups (1.4% vs. 4.2%; p = 0.5). Multivariate logistic regression analysis showed that ICA occlusion was associated with the absence of early neurological improvement ( p = 0.03; OR 1.78, 95% CI 1.05–3.04). However, the presence of ICA occlusion was not significantly associated with an unfavorable outcome at 3-month ( p = 0.44; OR 1.24, 95% CI 0.72–2.16) or with death ( p = 0.18; OR 0.57, 95% CI 0.25–1.29). Conclusion The patients with ICA occlusion treated with intravenous thrombolysis have a worse outcome than patients without it.