Benefits of intravenous thrombolysis in acute ischemic stroke related to extra cranial internal carotid dissection. Dream or reality?

Background Small clinical series have reported the safety of intravenous thrombolysis in ischemic stroke related to extracranial internal carotid dissection. However, no studies specifically analyzing the effects on stroke outcome are available. Aims Our goal was to evaluate whether patients with is...

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Veröffentlicht in:International journal of stroke 2012-01, Vol.7 (1), p.7-13
Hauptverfasser: Fuentes, Blanca, Masjuan, Jaime, de Leciñana, María Alonso, Simal, Patricia, Egido, José, Díaz-Otero, Fernando, Gil-Nuñez, Antonio, Martínez-Sánchez, Patricia, Díez-Tejedor, Exuperio
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container_end_page 13
container_issue 1
container_start_page 7
container_title International journal of stroke
container_volume 7
creator Fuentes, Blanca
Masjuan, Jaime
de Leciñana, María Alonso
Simal, Patricia
Egido, José
Díaz-Otero, Fernando
Gil-Nuñez, Antonio
Martínez-Sánchez, Patricia
Díez-Tejedor, Exuperio
description Background Small clinical series have reported the safety of intravenous thrombolysis in ischemic stroke related to extracranial internal carotid dissection. However, no studies specifically analyzing the effects on stroke outcome are available. Aims Our goal was to evaluate whether patients with ischemic stroke related to extracranial internal carotid dissection obtain any benefit from intravenous thrombolysis. Methods Multicenter, prospective and observational study conducted in four university hospitals from the Madrid Stroke Network. Consecutive ischemic stroke patients who received intravenous thrombolysis were included, as well as patients with extracranial internal carotid dissection regardless of intravenous thrombolysis treatment. Stroke severity (NIHSS) and three-month outcome (modified Rankin Scale) were compared between the following groups: (1) intravenous thrombolysis-treated patients with ischemic stroke related to extracranial internal carotid dissection vs. other causes of stroke; (2) intravenous thrombolysis-treated extracranial internal carotid dissection patients vs. nonintravenous thrombolysis treated. Outcome was rated at three-months using the modified Rankin Scale. A good outcome was defined as a modified Rankin Scale score ≤2. Results A total of 625 intravenous thrombolysis-treated patients were included; 16 (2·56%) had extracranial internal carotid dissection. Besides, 27 patients with extracranial internal carotid dissection and ischemic stroke who did not receive intravenous thrombolysis were also included. As compared with other etiologies, patients with extracranial internal carotid dissection were younger, had similar stroke severity and showed less improvement in their NIHSS score at Day 7 (1·38; (95% CI −3·77 to 6·54) vs. 6·81; (95% CI −5·99 to 7·63) P=0·004), but without differences in good outcomes at three-months (43·8% vs. 58·2%; NS). Extracranial internal carotid dissection intravenous thrombolysis-treated patients had more severe strokes at admission than those who were nonintravenous thrombolysis treated (median NIHSS: 15 vs. 7; P=0·031). Intravenous thrombolysis was safe in extracranial internal carotid dissection with no symptomatic hemorrhagic events; however, without differences in good outcome compared with the natural course of extracranial internal carotid dissection (nonintravenous thrombolysis treated) after adjustment for stroke severity (46·7% vs. 64·3%; NS). Conclusions As compared with other etiologies,
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Dream or reality?</title><source>Access via SAGE</source><source>MEDLINE</source><source>Wiley Journals</source><creator>Fuentes, Blanca ; Masjuan, Jaime ; de Leciñana, María Alonso ; Simal, Patricia ; Egido, José ; Díaz-Otero, Fernando ; Gil-Nuñez, Antonio ; Martínez-Sánchez, Patricia ; Díez-Tejedor, Exuperio</creator><creatorcontrib>Fuentes, Blanca ; Masjuan, Jaime ; de Leciñana, María Alonso ; Simal, Patricia ; Egido, José ; Díaz-Otero, Fernando ; Gil-Nuñez, Antonio ; Martínez-Sánchez, Patricia ; Díez-Tejedor, Exuperio ; Madrid Stroke Network ; Madrid Stroke Network</creatorcontrib><description>Background Small clinical series have reported the safety of intravenous thrombolysis in ischemic stroke related to extracranial internal carotid dissection. However, no studies specifically analyzing the effects on stroke outcome are available. Aims Our goal was to evaluate whether patients with ischemic stroke related to extracranial internal carotid dissection obtain any benefit from intravenous thrombolysis. Methods Multicenter, prospective and observational study conducted in four university hospitals from the Madrid Stroke Network. Consecutive ischemic stroke patients who received intravenous thrombolysis were included, as well as patients with extracranial internal carotid dissection regardless of intravenous thrombolysis treatment. Stroke severity (NIHSS) and three-month outcome (modified Rankin Scale) were compared between the following groups: (1) intravenous thrombolysis-treated patients with ischemic stroke related to extracranial internal carotid dissection vs. other causes of stroke; (2) intravenous thrombolysis-treated extracranial internal carotid dissection patients vs. nonintravenous thrombolysis treated. Outcome was rated at three-months using the modified Rankin Scale. A good outcome was defined as a modified Rankin Scale score ≤2. Results A total of 625 intravenous thrombolysis-treated patients were included; 16 (2·56%) had extracranial internal carotid dissection. Besides, 27 patients with extracranial internal carotid dissection and ischemic stroke who did not receive intravenous thrombolysis were also included. As compared with other etiologies, patients with extracranial internal carotid dissection were younger, had similar stroke severity and showed less improvement in their NIHSS score at Day 7 (1·38; (95% CI −3·77 to 6·54) vs. 6·81; (95% CI −5·99 to 7·63) P=0·004), but without differences in good outcomes at three-months (43·8% vs. 58·2%; NS). Extracranial internal carotid dissection intravenous thrombolysis-treated patients had more severe strokes at admission than those who were nonintravenous thrombolysis treated (median NIHSS: 15 vs. 7; P=0·031). Intravenous thrombolysis was safe in extracranial internal carotid dissection with no symptomatic hemorrhagic events; however, without differences in good outcome compared with the natural course of extracranial internal carotid dissection (nonintravenous thrombolysis treated) after adjustment for stroke severity (46·7% vs. 64·3%; NS). Conclusions As compared with other etiologies, stroke due to extracranial internal carotid dissection seems to obtain similar benefits from intravenous thrombolysis in outcome at three-months. Although intravenous thrombolysis is safe in stroke attributable to extracranial internal carotid dissection, no differences in outcome were found when comparing intravenous thrombolysis treated with nonintravenous thrombolysis-treated patients, even after adjustment for stroke severity.</description><identifier>ISSN: 1747-4930</identifier><identifier>EISSN: 1747-4949</identifier><identifier>DOI: 10.1111/j.1747-4949.2011.00637.x</identifier><identifier>PMID: 22017881</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Publishing Ltd</publisher><subject>Aged ; Carotid Artery, Internal, Dissection - complications ; cervical artery dissection ; Dreams ; Etiology ; Female ; Fibrinolytic Agents - administration &amp; dosage ; Hemorrhage ; Hospitals ; Humans ; Infusions, Intravenous ; Intravenous administration ; intravenous thrombolysis ; Ischemia ; Male ; Middle Aged ; outcome ; Recovery of Function ; Skull ; Stroke ; Stroke - etiology ; Stroke - pathology ; Stroke - therapy ; thrombolysis ; Thrombolytic Therapy - methods ; Tissue Plasminogen Activator - administration &amp; dosage ; Treatment Outcome</subject><ispartof>International journal of stroke, 2012-01, Vol.7 (1), p.7-13</ispartof><rights>2011 The Authors</rights><rights>2011 The Authors. International Journal of Stroke © 2011 World Stroke Organization</rights><rights>2011 The Authors. International Journal of Stroke © 2011 World Stroke Organization.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4837-3503290d598ffbb5d5b2b6f174c9404be82cbff3d931514e9c9e9c9bb21a57913</citedby><cites>FETCH-LOGICAL-c4837-3503290d598ffbb5d5b2b6f174c9404be82cbff3d931514e9c9e9c9bb21a57913</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1111/j.1747-4949.2011.00637.x$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1111/j.1747-4949.2011.00637.x$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,780,784,1417,21819,27924,27925,43621,43622,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22017881$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Fuentes, Blanca</creatorcontrib><creatorcontrib>Masjuan, Jaime</creatorcontrib><creatorcontrib>de Leciñana, María Alonso</creatorcontrib><creatorcontrib>Simal, Patricia</creatorcontrib><creatorcontrib>Egido, José</creatorcontrib><creatorcontrib>Díaz-Otero, Fernando</creatorcontrib><creatorcontrib>Gil-Nuñez, Antonio</creatorcontrib><creatorcontrib>Martínez-Sánchez, Patricia</creatorcontrib><creatorcontrib>Díez-Tejedor, Exuperio</creatorcontrib><creatorcontrib>Madrid Stroke Network</creatorcontrib><creatorcontrib>Madrid Stroke Network</creatorcontrib><title>Benefits of intravenous thrombolysis in acute ischemic stroke related to extra cranial internal carotid dissection. Dream or reality?</title><title>International journal of stroke</title><addtitle>Int J Stroke</addtitle><description>Background Small clinical series have reported the safety of intravenous thrombolysis in ischemic stroke related to extracranial internal carotid dissection. However, no studies specifically analyzing the effects on stroke outcome are available. Aims Our goal was to evaluate whether patients with ischemic stroke related to extracranial internal carotid dissection obtain any benefit from intravenous thrombolysis. Methods Multicenter, prospective and observational study conducted in four university hospitals from the Madrid Stroke Network. Consecutive ischemic stroke patients who received intravenous thrombolysis were included, as well as patients with extracranial internal carotid dissection regardless of intravenous thrombolysis treatment. Stroke severity (NIHSS) and three-month outcome (modified Rankin Scale) were compared between the following groups: (1) intravenous thrombolysis-treated patients with ischemic stroke related to extracranial internal carotid dissection vs. other causes of stroke; (2) intravenous thrombolysis-treated extracranial internal carotid dissection patients vs. nonintravenous thrombolysis treated. Outcome was rated at three-months using the modified Rankin Scale. A good outcome was defined as a modified Rankin Scale score ≤2. Results A total of 625 intravenous thrombolysis-treated patients were included; 16 (2·56%) had extracranial internal carotid dissection. Besides, 27 patients with extracranial internal carotid dissection and ischemic stroke who did not receive intravenous thrombolysis were also included. As compared with other etiologies, patients with extracranial internal carotid dissection were younger, had similar stroke severity and showed less improvement in their NIHSS score at Day 7 (1·38; (95% CI −3·77 to 6·54) vs. 6·81; (95% CI −5·99 to 7·63) P=0·004), but without differences in good outcomes at three-months (43·8% vs. 58·2%; NS). Extracranial internal carotid dissection intravenous thrombolysis-treated patients had more severe strokes at admission than those who were nonintravenous thrombolysis treated (median NIHSS: 15 vs. 7; P=0·031). Intravenous thrombolysis was safe in extracranial internal carotid dissection with no symptomatic hemorrhagic events; however, without differences in good outcome compared with the natural course of extracranial internal carotid dissection (nonintravenous thrombolysis treated) after adjustment for stroke severity (46·7% vs. 64·3%; NS). Conclusions As compared with other etiologies, stroke due to extracranial internal carotid dissection seems to obtain similar benefits from intravenous thrombolysis in outcome at three-months. Although intravenous thrombolysis is safe in stroke attributable to extracranial internal carotid dissection, no differences in outcome were found when comparing intravenous thrombolysis treated with nonintravenous thrombolysis-treated patients, even after adjustment for stroke severity.</description><subject>Aged</subject><subject>Carotid Artery, Internal, Dissection - complications</subject><subject>cervical artery dissection</subject><subject>Dreams</subject><subject>Etiology</subject><subject>Female</subject><subject>Fibrinolytic Agents - administration &amp; dosage</subject><subject>Hemorrhage</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Infusions, Intravenous</subject><subject>Intravenous administration</subject><subject>intravenous thrombolysis</subject><subject>Ischemia</subject><subject>Male</subject><subject>Middle Aged</subject><subject>outcome</subject><subject>Recovery of Function</subject><subject>Skull</subject><subject>Stroke</subject><subject>Stroke - etiology</subject><subject>Stroke - pathology</subject><subject>Stroke - therapy</subject><subject>thrombolysis</subject><subject>Thrombolytic Therapy - methods</subject><subject>Tissue Plasminogen Activator - administration &amp; dosage</subject><subject>Treatment Outcome</subject><issn>1747-4930</issn><issn>1747-4949</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkcFu1DAQhiNERUvhFZBvnBLsOI5jCQnBQrtFVTkU6NGynQn1Nolb24HdB-C9cUi719aS5ZHm__7x6M8yRHBB0nm3KQiveF6JShQlJqTAuKa82D7LjvaN5_ua4sPsZQgbjCvGaf0iOywTxJuGHGV_P8EInY0BuQ7ZMXr1G0Y3BRSvvRu063fBhtRAykwRkA3mGgZrUIje3QDy0KsILYoOwTbByHg1WtXPVuDHVBjlXbQtam0IYKJ1Y4E-e1ADcj7hqrdx9-FVdtCpPsDr-_c4-3Hy5ftqnZ9_Oz1bfTzPTdVQnlOGaSlwy0TTdVqzlulS111a04gKVxqa0uiuo62ghJEKhBHz1bokinFB6HH2dvG99e5ughDlkDaCvlcjpKWlKDFvRF3yx5WkEbSmZFY2i9J4F4KHTt56Oyi_kwTLOS25kXMQcg5FzmnJ_2nJbULf3A-Z9ADtHnyIJwneL4I_tofdk43l2dfLVCScLXhQv0Bu3DQnEp7yr3zhbIiw3Y9V_kbWnHImry5O5c-r1eXJmq0lpf8ABKnEnw</recordid><startdate>201201</startdate><enddate>201201</enddate><creator>Fuentes, Blanca</creator><creator>Masjuan, Jaime</creator><creator>de Leciñana, María Alonso</creator><creator>Simal, Patricia</creator><creator>Egido, José</creator><creator>Díaz-Otero, Fernando</creator><creator>Gil-Nuñez, Antonio</creator><creator>Martínez-Sánchez, Patricia</creator><creator>Díez-Tejedor, Exuperio</creator><general>Blackwell Publishing Ltd</general><general>SAGE Publications</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>7TK</scope></search><sort><creationdate>201201</creationdate><title>Benefits of intravenous thrombolysis in acute ischemic stroke related to extra cranial internal carotid dissection. Dream or reality?</title><author>Fuentes, Blanca ; Masjuan, Jaime ; de Leciñana, María Alonso ; Simal, Patricia ; Egido, José ; Díaz-Otero, Fernando ; Gil-Nuñez, Antonio ; Martínez-Sánchez, Patricia ; Díez-Tejedor, Exuperio</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4837-3503290d598ffbb5d5b2b6f174c9404be82cbff3d931514e9c9e9c9bb21a57913</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Aged</topic><topic>Carotid Artery, Internal, Dissection - complications</topic><topic>cervical artery dissection</topic><topic>Dreams</topic><topic>Etiology</topic><topic>Female</topic><topic>Fibrinolytic Agents - administration &amp; dosage</topic><topic>Hemorrhage</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Infusions, Intravenous</topic><topic>Intravenous administration</topic><topic>intravenous thrombolysis</topic><topic>Ischemia</topic><topic>Male</topic><topic>Middle Aged</topic><topic>outcome</topic><topic>Recovery of Function</topic><topic>Skull</topic><topic>Stroke</topic><topic>Stroke - etiology</topic><topic>Stroke - pathology</topic><topic>Stroke - therapy</topic><topic>thrombolysis</topic><topic>Thrombolytic Therapy - methods</topic><topic>Tissue Plasminogen Activator - administration &amp; dosage</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Fuentes, Blanca</creatorcontrib><creatorcontrib>Masjuan, Jaime</creatorcontrib><creatorcontrib>de Leciñana, María Alonso</creatorcontrib><creatorcontrib>Simal, Patricia</creatorcontrib><creatorcontrib>Egido, José</creatorcontrib><creatorcontrib>Díaz-Otero, Fernando</creatorcontrib><creatorcontrib>Gil-Nuñez, Antonio</creatorcontrib><creatorcontrib>Martínez-Sánchez, Patricia</creatorcontrib><creatorcontrib>Díez-Tejedor, Exuperio</creatorcontrib><creatorcontrib>Madrid Stroke Network</creatorcontrib><creatorcontrib>Madrid Stroke Network</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>Neurosciences Abstracts</collection><jtitle>International journal of stroke</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Fuentes, Blanca</au><au>Masjuan, Jaime</au><au>de Leciñana, María Alonso</au><au>Simal, Patricia</au><au>Egido, José</au><au>Díaz-Otero, Fernando</au><au>Gil-Nuñez, Antonio</au><au>Martínez-Sánchez, Patricia</au><au>Díez-Tejedor, Exuperio</au><aucorp>Madrid Stroke Network</aucorp><aucorp>Madrid Stroke Network</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Benefits of intravenous thrombolysis in acute ischemic stroke related to extra cranial internal carotid dissection. Dream or reality?</atitle><jtitle>International journal of stroke</jtitle><addtitle>Int J Stroke</addtitle><date>2012-01</date><risdate>2012</risdate><volume>7</volume><issue>1</issue><spage>7</spage><epage>13</epage><pages>7-13</pages><issn>1747-4930</issn><eissn>1747-4949</eissn><abstract>Background Small clinical series have reported the safety of intravenous thrombolysis in ischemic stroke related to extracranial internal carotid dissection. However, no studies specifically analyzing the effects on stroke outcome are available. Aims Our goal was to evaluate whether patients with ischemic stroke related to extracranial internal carotid dissection obtain any benefit from intravenous thrombolysis. Methods Multicenter, prospective and observational study conducted in four university hospitals from the Madrid Stroke Network. Consecutive ischemic stroke patients who received intravenous thrombolysis were included, as well as patients with extracranial internal carotid dissection regardless of intravenous thrombolysis treatment. Stroke severity (NIHSS) and three-month outcome (modified Rankin Scale) were compared between the following groups: (1) intravenous thrombolysis-treated patients with ischemic stroke related to extracranial internal carotid dissection vs. other causes of stroke; (2) intravenous thrombolysis-treated extracranial internal carotid dissection patients vs. nonintravenous thrombolysis treated. Outcome was rated at three-months using the modified Rankin Scale. A good outcome was defined as a modified Rankin Scale score ≤2. Results A total of 625 intravenous thrombolysis-treated patients were included; 16 (2·56%) had extracranial internal carotid dissection. Besides, 27 patients with extracranial internal carotid dissection and ischemic stroke who did not receive intravenous thrombolysis were also included. As compared with other etiologies, patients with extracranial internal carotid dissection were younger, had similar stroke severity and showed less improvement in their NIHSS score at Day 7 (1·38; (95% CI −3·77 to 6·54) vs. 6·81; (95% CI −5·99 to 7·63) P=0·004), but without differences in good outcomes at three-months (43·8% vs. 58·2%; NS). Extracranial internal carotid dissection intravenous thrombolysis-treated patients had more severe strokes at admission than those who were nonintravenous thrombolysis treated (median NIHSS: 15 vs. 7; P=0·031). Intravenous thrombolysis was safe in extracranial internal carotid dissection with no symptomatic hemorrhagic events; however, without differences in good outcome compared with the natural course of extracranial internal carotid dissection (nonintravenous thrombolysis treated) after adjustment for stroke severity (46·7% vs. 64·3%; NS). Conclusions As compared with other etiologies, stroke due to extracranial internal carotid dissection seems to obtain similar benefits from intravenous thrombolysis in outcome at three-months. Although intravenous thrombolysis is safe in stroke attributable to extracranial internal carotid dissection, no differences in outcome were found when comparing intravenous thrombolysis treated with nonintravenous thrombolysis-treated patients, even after adjustment for stroke severity.</abstract><cop>Oxford, UK</cop><pub>Blackwell Publishing Ltd</pub><pmid>22017881</pmid><doi>10.1111/j.1747-4949.2011.00637.x</doi><tpages>7</tpages></addata></record>
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subjects Aged
Carotid Artery, Internal, Dissection - complications
cervical artery dissection
Dreams
Etiology
Female
Fibrinolytic Agents - administration & dosage
Hemorrhage
Hospitals
Humans
Infusions, Intravenous
Intravenous administration
intravenous thrombolysis
Ischemia
Male
Middle Aged
outcome
Recovery of Function
Skull
Stroke
Stroke - etiology
Stroke - pathology
Stroke - therapy
thrombolysis
Thrombolytic Therapy - methods
Tissue Plasminogen Activator - administration & dosage
Treatment Outcome
title Benefits of intravenous thrombolysis in acute ischemic stroke related to extra cranial internal carotid dissection. Dream or reality?
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