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Journal of Neurology
Published in: Journal of Neurology 9/2015

01-09-2015 | Original Communication

Safety and outcomes of intravenous thrombolysis in dissection-related ischemic stroke: an international multicenter study and comprehensive meta-analysis of reported case series

Authors: Georgios Tsivgoulis, Ramin Zand, Aristeidis H. Katsanos, Vijay K. Sharma, Nitin Goyal, Christos Krogias, Apostolos Safouris, Konstantinos Vadikolias, Konstantinos Voumvourakis, Anne W. Alexandrov, Marc D. Malkoff, Andrei V. Alexandrov

Published in: Journal of Neurology | Issue 9/2015

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Abstract

The safety and efficacy of intravenous thrombolysis (IVT) in dissection-related ischemic stroke (DRIS) has not been established. We sought to determine safety and recovery rates of IVT in DRIS using prospective, international, multicenter data and by conducting a comprehensive meta-analysis of reported case series. We analyzed consecutive DRIS patients treated with IVT according to national guidelines during a 5-year period at six tertiary-care stroke centers, and also conducted a comprehensive review and meta-analysis of all available case series reporting safety outcomes in DRIS treated with IVT according to PRISMA guidelines. A total of 39 DRIS patients (mean age 60 ± 18 years; 59 % men; median NIHSS 13 points, IQR 9–17) received IVT in our multicenter study. Symptomatic intracranial hemorrhage (sICH), in-hospital mortality, complete recanalization, favorable functional outcome (FFO; mRS-score of 0–1) and functional independence (FI; mRS-score of 0–2) were 0 % (adjusted Wald 95 % CI 0–8 %), 10 % (3–24 %), 55 % (40–70 %), 61 % (45–74 %) and 68 % (52–81 %). The pooled sICH and mortality rates in meta-analysis including 10 case series (234 IVT-DRIS patients) were 2 % (0–5 %) and 4 % (0–8 %). The pooled recanalization, FFO and FI rates were 45 % (26–67 %), 41 % (29–54 %) and 61 % (48–72 %), respectively. Substantial heterogeneity was only found for FFO (I 2 = 61 %; p = 0.006). Subsequent meta-regression analysis identified baseline NIHSS and dissection in the posterior circulation as independent predictors of FFO (p < 0.05), accounting for FFO variance across different studies. Our prospective, international data coupled with comprehensive meta-analysis results underscore IVT safety in DRIS, while further independent validation is required in larger observational registries or RCTs.
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Metadata
Title
Safety and outcomes of intravenous thrombolysis in dissection-related ischemic stroke: an international multicenter study and comprehensive meta-analysis of reported case series
Authors
Georgios Tsivgoulis
Ramin Zand
Aristeidis H. Katsanos
Vijay K. Sharma
Nitin Goyal
Christos Krogias
Apostolos Safouris
Konstantinos Vadikolias
Konstantinos Voumvourakis
Anne W. Alexandrov
Marc D. Malkoff
Andrei V. Alexandrov
Publication date
01-09-2015
Publisher
Springer Berlin Heidelberg
Published in
Journal of Neurology / Issue 9/2015
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI
https://doi.org/10.1007/s00415-015-7829-x

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