Intravenous Thrombolysis in Patients With Cervical Artery Dissection: A Secondary Analysis of the STOP-CAD Study.
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Shu Liqi, Akpokiere Favour, Mandel Daniel M, Field Thalia S, Leon Guerrero Christopher R, Henninger Nils, Muppa Jayachandra, Affan Muhammad, Haq Lodhi Omair U, Heldner Mirjam R, Antonenko Kateryna, Seiffge David J, Arnold Marcel, Salehi Omran Setareh, Crandall Ross, Lester Evan, López-Mena Diego, Arauz Antonio, Nehme Ahmad, Boulanger Marion, Touzé Emmanuel, Sousa João André, Sargento-Freitas João, Barata Vasco, Castro-Chaves Paulo, Brito Maria T, Khan Muhib, Mallick Dania, Rothstein Aaron, Khazaal Ossama, Kaufmann Josefin E, Engelter Stefan T, Traenka Christopher, Aguiar de Sousa Diana, Soares Mafalda D, Rosa Sara B, Zhou Lily, Gandhi Preet, Mancini Steven, Metanis Issa, Leker Ronen R, Pan Kelly, Dantu Vishnu, Baumgartner Karl, Burton Tina M, Von Rennenberg Regina, Nolte Christian H, Choi Richard, MacDonald Jason, Bavarsad Shahripour Reza, Guo Xiaofan, Ghannam Malik, Almajali Mohammad, Samaniego Edgar A, Rioux Bastien, Zine-Eddine Faycal, Poppe Alexandre, Fonseca Ana C, Baptista Maria F, Cruz Diana, Romoli Michele, De Marco Giovanna, Longoni Marco, Keser Zafer, Griffin Kim J, Kuohn Lindsey, Frontera Jennifer A, Amar Jordan Y, Giles James A, Zedde Marialuisa, Pascarella Rosario, Grisendi Ilaria, Nzwalo Hipolito, Liebeskind David S, Molaie Amir, Cavalier Annie, Kam Wayneho, Mac Grory Brian, Al Kasab Sami, Anadani Mohammad, Kicielinski Kimberly P, Eltatawy Ali, Chervak Lina, Chulluncuy Rivas Roberto, Aziz Yasmin N, Mistry Eva A, Bakradze Ekaterina, Tran Thanh L, Rodrigo-Gisbert Marc, Requena Manuel, Saleh Velez Faddi G, Garcia Jorge Ortiz, Muddasani Varsha, de Havenon Adam, Sanchez Sebastian, Vishnu Venugopalan Y, Yaddanapudi Sridhara, Adams Latasha, Browngoehl Abigail, Ranasinghe Tamra, Dunston Randy, Lynch Zachary, Penckofer Mary, Siegler James E, Mayer Silvia, Willey Joshua Z, Zubair Adeel S, Cheng Yee Kuang, Sharma Richa, Marto João Pedro, Krupka Danna, Klein Piers, Nguyen Thanh N, Asad Syed Daniyal, Sarwat Zoha, Balabhadra Anvesh, Patel Shivam, Secchi Thais, Martins Sheila C, Mantovani Gabriel P, Kim Young Dae, Krishnaiah Balaji, Elangovan Cheran, Lingam Sivani, Qureshi Abid Y, Fridman Sebastian, Alvarado Alonso, Khasiyev Farid, Linares Guillermo, Mannino Marina, Terruso Valeria, Tountopoulou Argyro, Tentolouris-Piperas Vasileios, Martinez-Marino Manuel M, Carrasco Wall Victor, Indraswari Fransisca, El Jamal Sleiman E, Liu Shilin, Zhou Min, Alvi Muhammad M, Ali Farman, Sarvath Mohammed, Morsi Rami Z, Kass-Hout Tareq, Shi Feina, Zhang Jinhua, Sokhi Dilraj, Said Jamil, Mongare Newnex, Simpkins Alexis N, Gomez Roberto, Sen Shayak, Ghani Mohammad, Elnazeir Marwa, Wangqin Runqi, Xiao Han, Kala Narendra S, Khan Farhan, Stretz Christoph, Mohammadzadeh Nahid, Goldstein Eric D, Furie Karen, Yaghi Shadi
Аннотация
METHODS: This analysis used data from the retrospective STOP-CAD study and included patients with spontaneous CeAD who presented within 1 day of acute ischemic stroke symptoms. Patients were dichotomized into those who received IVT and those managed without IVT. We assessed the association between IVT and 90-day functional independence (modified Rankin Scale scores 0-2) and the incidence of symptomatic intracranial hemorrhage (ICH, defined as ICH causing new or worsening neurologic symptoms within 72 hours after CeAD diagnosis).
RESULTS: This study included 1,653 patients from the original STOP-CAD cohort of 4,023. The median age was 49 years, and 35.1% were women; 512 (31.0%) received IVT. IVT was associated with 90-day functional independence (adjusted odds ratio [aOR] = 1.67, 95% CI 1.23-2.28, p = 0.001), but not with symptomatic ICH (aOR = 1.52, 95% CI 0.79-2.92, p = 0.215).
DISCUSSION: In patients with spontaneous CeAD and suspected ischemic stroke, IVT improved functional outcomes, without increasing symptomatic ICH risk. These findings support current guideline recommendations to consider thrombolysis for otherwise eligible patients with CeAD.
CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that IVT significantly increases the probability of 90-day functional independence in patients with CeAD.