Should Patients With Acute Minor Ischemic Stroke With Isolated Internal Carotid Artery Occlusion Be Thrombolysed?
Details
Serval ID
serval:BIB_C90FB2944BD6
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Should Patients With Acute Minor Ischemic Stroke With Isolated Internal Carotid Artery Occlusion Be Thrombolysed?
Journal
Stroke
Working group(s)
ISOCAR and MINOR-STROKE Collaborators
Contributor(s)
Ben Hassen W., Lapergue B., Lucas L., Leys D., Philippeau F., Bennani O., Mechtouff L., Klapczynski F., Detante O., Costalat V., Mione G., Gazzola S., Debiais S., Cakmak S., Grigoras V., Denier C., Smadja D., Mounier-Vehier F., Peres R., Spelle L., Bricout N., Bracard S., Triquenot A., Lyoubi A., Cottier J.P., Duong D.L., Ollivier C.
ISSN
1524-4628 (Electronic)
ISSN-L
0039-2499
Publication state
Published
Issued date
11/2022
Peer-reviewed
Oui
Volume
53
Number
11
Pages
3304-3312
Language
english
Notes
Publication types: Multicenter Study ; Journal Article
Publication Status: ppublish
Publication Status: ppublish
Abstract
We recently reported a worrying 30% rate of early neurological deterioration (END) occurring within 24 hours following intravenous thrombolysis (IVT) in minor stroke with isolated internal carotid artery occlusion (ie, without additional intracranial occlusion), mainly due to artery-to-artery embolism. Here, we hypothesize that in this setting IVT-as compared to no-IVT-may foster END, in particular by favoring artery-to-artery embolism from thrombus fragmentation.
From a large multicenter retrospective database, we compared minor stroke (National Institutes of Health Stroke Scale score <6) isolated internal carotid artery occlusion patients treated within 4.5 hours of symptoms onset with either IVT or antithrombotic therapy between 2006 and 2020 (inclusion date varied among centers). Primary outcome was END within 24 hours (≥4 National Institutes of Health Stroke Scale points increase within 24 hours), and secondary outcomes were END within 7 days (END <sub>7d</sub> ) and 3-month modified Rankin Scale score 0 to 1.
Overall, 189 patients were included (IVT=95; antithrombotics=94 [antiplatelets, n=58, anticoagulants, n=36]) from 34 centers. END within 24 hours and END <sub>7d</sub> occurred in 46 (24%) and 60 (32%) patients, respectively. Baseline clinical and radiological variables were similar between the 2 groups, except significantly higher National Institutes of Health Stroke Scale (median 3 versus 2) and shorter onset-to-imaging (124 versus 149min) in the IVT group. END within 24 hours was more frequent following IVT (33% versus 16%, adjusted hazard ratio, 2.01 [95% CI, 1.07-3.92]; P=0.03), driven by higher odds of artery-to-artery embolism (20% versus 9%, P=0.09). However, END <sub>7d</sub> and 3-month modified Rankin Scale score of 0 to 1 did not significantly differ between the 2 groups (END <sub>7d</sub> : adjusted hazard ratio, 1.29 [95% CI, 0.75-2.23]; P=0.37; modified Rankin Scale score of 0-1: adjusted odds ratio, 1.1 [95% CI, 0.6-2.2]; P=0.71). END <sub>7d</sub> occurred earlier in the IVT group: median imaging-to-END 2.6 hours (interquartile range, 1.9-10.1) versus 20.4 hours (interquartile range, 7.8-34.4), respectively, P<0.01.
In our population of minor strokes with iICAO, although END rate at 7 days and 3-month outcome were similar between the 2 groups, END-particularly END due to artery-to-artery embolism-occurred earlier following IVT. Prospective studies are warranted to further clarify the benefit/risk profile of IVT in this population.
From a large multicenter retrospective database, we compared minor stroke (National Institutes of Health Stroke Scale score <6) isolated internal carotid artery occlusion patients treated within 4.5 hours of symptoms onset with either IVT or antithrombotic therapy between 2006 and 2020 (inclusion date varied among centers). Primary outcome was END within 24 hours (≥4 National Institutes of Health Stroke Scale points increase within 24 hours), and secondary outcomes were END within 7 days (END <sub>7d</sub> ) and 3-month modified Rankin Scale score 0 to 1.
Overall, 189 patients were included (IVT=95; antithrombotics=94 [antiplatelets, n=58, anticoagulants, n=36]) from 34 centers. END within 24 hours and END <sub>7d</sub> occurred in 46 (24%) and 60 (32%) patients, respectively. Baseline clinical and radiological variables were similar between the 2 groups, except significantly higher National Institutes of Health Stroke Scale (median 3 versus 2) and shorter onset-to-imaging (124 versus 149min) in the IVT group. END within 24 hours was more frequent following IVT (33% versus 16%, adjusted hazard ratio, 2.01 [95% CI, 1.07-3.92]; P=0.03), driven by higher odds of artery-to-artery embolism (20% versus 9%, P=0.09). However, END <sub>7d</sub> and 3-month modified Rankin Scale score of 0 to 1 did not significantly differ between the 2 groups (END <sub>7d</sub> : adjusted hazard ratio, 1.29 [95% CI, 0.75-2.23]; P=0.37; modified Rankin Scale score of 0-1: adjusted odds ratio, 1.1 [95% CI, 0.6-2.2]; P=0.71). END <sub>7d</sub> occurred earlier in the IVT group: median imaging-to-END 2.6 hours (interquartile range, 1.9-10.1) versus 20.4 hours (interquartile range, 7.8-34.4), respectively, P<0.01.
In our population of minor strokes with iICAO, although END rate at 7 days and 3-month outcome were similar between the 2 groups, END-particularly END due to artery-to-artery embolism-occurred earlier following IVT. Prospective studies are warranted to further clarify the benefit/risk profile of IVT in this population.
Keywords
Humans, Fibrinolytic Agents/therapeutic use, Thrombolytic Therapy/methods, Ischemic Stroke, Carotid Artery, Internal/diagnostic imaging, Retrospective Studies, Treatment Outcome, Arterial Occlusive Diseases/diagnostic imaging, Arterial Occlusive Diseases/drug therapy, Arterial Occlusive Diseases/complications, Stroke/diagnostic imaging, Stroke/drug therapy, Stroke/etiology, Carotid Artery Diseases/complications, Thrombosis/drug therapy, Anticoagulants/therapeutic use, Brain Ischemia/diagnostic imaging, Brain Ischemia/drug therapy, Brain Ischemia/complications, Thrombectomy/methods, anticoagulant, carotid artery, internal, embolism, ischemic stroke, thrombus
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Create date
20/09/2022 14:45
Last modification date
25/02/2023 7:46
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