Safety and functional outcome of thrombolysis in dissection-related ischemic stroke: a meta-analysis of individual patient data.

Détails

ID Serval
serval:BIB_C1E8D12F9E72
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Safety and functional outcome of thrombolysis in dissection-related ischemic stroke: a meta-analysis of individual patient data.
Périodique
Stroke; A Journal of Cerebral Circulation
Auteur(s)
Zinkstok S.M., Vergouwen M.D., Engelter S.T., Lyrer P.A., Bonati L.H., Arnold M., Mattle H.P., Fischer U., Sarikaya H., Baumgartner R.W., Georgiadis D., Odier C., Michel P., Putaala J., Griebe M., Wahlgren N., Ahmed N., van Geloven N., de Haan R.J., Nederkoorn P.J.
ISSN
1524-4628 (Electronic)
ISSN-L
0039-2499
Statut éditorial
Publié
Date de publication
2011
Peer-reviewed
Oui
Volume
42
Numéro
9
Pages
2515-2520
Langue
anglais
Résumé
Background and Purpose-The safety and efficacy of thrombolysis in cervical artery dissection (CAD) are controversial. The aim of this meta-analysis was to pool all individual patient data and provide a valid estimate of safety and outcome of thrombolysis in CAD.Methods-We performed a systematic literature search on intravenous and intra-arterial thrombolysis in CAD. We calculated the rates of pooled symptomatic intracranial hemorrhage and mortality and indirectly compared them with matched controls from the Safe Implementation of Thrombolysis in Stroke-International Stroke Thrombolysis Register. We applied multivariate regression models to identify predictors of excellent (modified Rankin Scale=0 to 1) and favorable (modified Rankin Scale=0 to 2) outcome.Results-We obtained individual patient data of 180 patients from 14 retrospective series and 22 case reports. Patients were predominantly female (68%), with a mean +/- SD age of 46 +/- 11 years. Most patients presented with severe stroke (median National Institutes of Health Stroke Scale score=16). Treatment was intravenous thrombolysis in 67% and intra-arterial thrombolysis in 33%. Median follow-up was 3 months. The pooled symptomatic intracranial hemorrhage rate was 3.1% (95% CI, 1.3 to 7.2). Overall mortality was 8.1% (95% CI, 4.9 to 13.2), and 41.0% (95% CI, 31.4 to 51.4) had an excellent outcome. Stroke severity was a strong predictor of outcome. Overlapping confidence intervals of end points indicated no relevant differences with matched controls from the Safe Implementation of Thrombolysis in Stroke-International Stroke Thrombolysis Register.Conclusions-Safety and outcome of thrombolysis in patients with CAD-related stroke appear similar to those for stroke from all causes. Based on our findings, thrombolysis should not be withheld in patients with CAD. (Stroke. 2011;42:2515-2520.)
Mots-clé
Brain Ischemia/etiology, Brain Ischemia/therapy, Carotid Artery Diseases/complications, Carotid Artery Diseases/therapy, Female, Humans, Intracranial Hemorrhages/etiology, Intracranial Hemorrhages/therapy, Male, Meta-Analysis as Topic, Stroke/etiology, Stroke/therapy, Thrombolytic Therapy/adverse effects, Thrombolytic Therapy/methods
Pubmed
Web of science
Open Access
Oui
Création de la notice
23/09/2011 14:05
Dernière modification de la notice
09/05/2019 0:48
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