Efficacy and safety of endovascular treatment in acute ischemic stroke due to cervical artery dissection: A 15-year consecutive case series.

Details

Serval ID
serval:BIB_8E42CD38D30C
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Efficacy and safety of endovascular treatment in acute ischemic stroke due to cervical artery dissection: A 15-year consecutive case series.
Journal
International journal of stroke
Author(s)
Bernardo F., Nannoni S., Strambo D., Puccinelli F., Saliou G., Michel P., Sirimarco G.
ISSN
1747-4949 (Electronic)
ISSN-L
1747-4930
Publication state
Published
Issued date
06/2019
Peer-reviewed
Oui
Volume
14
Number
4
Pages
381-389
Language
english
Notes
Publication types: Comparative Study ; Evaluation Study ; Journal Article
Publication Status: ppublish
Abstract
Limited observational data are available on endovascular treatment in acute ischemic stroke due to cervical artery dissection. Three studies comparing endovascular treatment with standard medical therapy or intravenous thrombolysis in cervical artery dissection-related acute ischemic stroke did not demonstrate superiority of endovascular treatment. Efficacy and the choice of endovascular treatment technique in this setting remain to be established.
To assess the potential efficacy and safety of endovascular treatment compared to intravenous thrombolysis alone or to no revascularization treatment in our center.
We selected all consecutive patients with cervical artery dissection-related acute ischemic stroke and intracranial occlusion from the Acute STroke Registry and Analysis of Lausanne between 2003 and 2017. We compared clinical and neuroimaging data of patients treated by endovascular treatment versus patients receiving intravenous thrombolysis or patients without revascularization treatment. Safety analysis included symptomatic intracranial hemorrhage, major radiological hemorrhages (parenchymal hematoma 1, parenchymal hematoma 2, and subarachnoid hemorrhage) and mortality within seven days. We assessed favorable clinical outcome (modified Rankin Scale 0-2) at three months using a binary logistic regression model.
Of the 109 patients included, 24 had endovascular treatment, 38 received intravenous thrombolysis alone, and 47 had no revascularization treatment. Endovascular treatment patients had a higher rate of recanalization at 24 h. Major radiological hemorrhages occurred more often in endovascular treatment patients (all with bridging therapy) than in patients without revascularization treatment (p = 0.026), with no differences in symptomatic intracranial hemorrhage or mortality within seven days. Favorable clinical outcome at three months did not differ between groups (endovascular treatment versus intravenous thrombolysis p = 0.407; endovascular treatment versus no revascularization treatment p = 0.580).
In this single-center cohort of cervical artery dissection-related acute ischemic stroke with intracranial occlusion, endovascular treatment with prior intravenous thrombolysis may increase the risk of major radiological but not symptomatic intracranial hemorrhage. Despite the lack of clear superiority in our cohort, endovascular treatment should currently not be withheld in these patients.
Keywords
Administration, Intravenous, Adult, Brain Ischemia/mortality, Brain Ischemia/therapy, Cerebral Revascularization/methods, Endovascular Procedures, Female, Humans, Intracranial Hemorrhages/etiology, Male, Middle Aged, Postoperative Complications, Stroke/mortality, Stroke/therapy, Survival Analysis, Thrombolytic Therapy, Tomography, X-Ray Computed, Treatment Outcome, Vertebral Artery/diagnostic imaging, Vertebral Artery Dissection/mortality, Vertebral Artery Dissection/therapy, Cervical artery dissection, acute ischemic stroke, endovascular treatment, intravenous thrombolysis
Pubmed
Web of science
Create date
31/05/2019 13:07
Last modification date
19/02/2020 7:19
Usage data