Systemic thrombolysis in patients with acute ischemic stroke and Internal Carotid ARtery Occlusion: the ICARO study.
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Paciaroni Maurizio, Balucani Clotilde, Agnelli Giancarlo, Caso Valeria, Silvestrelli Giorgio, Grotta James C, Demchuk Andrew M, Sohn Sung-Il, Orlandi Giovanni, Leys Didier, Pezzini Alessandro, Alexandrov Andrei V, Silvestrini Mauro, Fofi Luisa, Barlinn Kristian, Inzitari Domenico, Ferrarese Carlo, Tassi Rossana, Tsivgoulis Georgios, Consoli Domenico, Baldi Antonio, Bovi Paolo, Luda Emilio, Galletti Giampiero, Invernizzi Paolo, DeLodovici Maria Luisa, Corea Francesco, Del Sette Massimo, Monaco Serena, Marcheselli Simona, Alberti Andrea, Venti Michele, Acciarresi Monica, D'Amore Cataldo, Macellari Federica, Lanari Alessia, Previdi Paolo, Gonzales Nicole R, Pandurengan Renganayaki K, Vahidy Farhaan S, Sline Melvin, Bal Simerpreet S, Chiti Alberto, Gialdini Gino, Dumont Frederic, Cordonnier Charlotte, Debette Stéphanie, Padovani Alessandro, Cerqua Raffaella, Bodechtel Ulf, Kepplinger Jessica, Nesi Mascia, Nencini Patrizia, Beretta Simone, Trentini Claudia, Martini Giuseppe, Piperidou Charitomeni, Heliopoulos Ioannis, D'Anna Sebastiano, Cappellari Manuel, Donati Edoardo, Bono Giorgio, Traverso Elisabetta, Toni Danilo
Аннотация
METHODS: ICARO was a case-control multicenter study on prospectively collected data. Patients with acute ischemic stroke and ICA occlusion treated with intravenous recombinant tissue-type plasminogen activator within 4.5 hours from symptom onset (cases) were compared to matched patients with acute stroke and ICA occlusion not treated with recombinant tissue-type plasminogen activator (controls). Cases and controls were matched for age, gender, and stroke severity. The efficacy outcome was disability at 90 days assessed by the modified Rankin Scale, dichotomized as favorable (score of 0-2) or unfavorable (score of 3-6). Safety outcomes were death and any intracranial bleeding.
RESULTS: Included in the analysis were 253 cases and 253 controls. Seventy-three cases (28.9%) had a favorable outcome as compared with 52 controls (20.6%; adjusted odds ratio (OR), 1.80; 95% confidence interval [CI], 1.03-3.15; P=0.037). A total of 104 patients died, 65 cases (25.7%) and 39 controls (15.4%; adjusted OR, 2.28; 95% CI, 1.36-3.22; P=0.001). There were more fatal bleedings (2.8% versus 0.4%; OR, 7.17; 95% CI, 0.87-58.71; P=0.068) in the cases than in the controls.
CONCLUSIONS: In patients with stroke attributable to ICA occlusion, thrombolytic therapy results in a significant reduction in the proportion of patients dependent in activities of daily living. Increases in death and any intracranial bleeding were the trade-offs for this clinical benefit.