Intravenous Thrombolysis in Patients With Cervical Artery Dissection: A Secondary Analysis of the STOP-CAD Study.
Shu L., Akpokiere F., Mandel DM., Field TS., Leon Guerrero CR., Henninger N., Muppa J., Affan M., Haq Lodhi OU., Heldner MR., Antonenko K., Seiffge DJ., Arnold M., Salehi Omran S., Crandall R., Lester E., López-Mena D., Arauz A., Nehme A., Boulanger M., Touzé E., Sousa JA., Sargento-Freitas J., Barata V., Castro-Chaves P., Brito MT., Khan M., Mallick D., Rothstein A., Khazaal O., Kaufmann JE., Engelter ST., Traenka C., Aguiar de Sousa D., Soares MD., Rosa SB., Zhou L., Gandhi P., Mancini S., Metanis I., Leker RR., Pan K., Dantu V., Baumgartner K., Burton TM., Von Rennenberg R., Nolte CH., Choi R., MacDonald J., Bavarsad Shahripour R., Guo X., Ghannam M., Almajali M., Samaniego EA., Rioux B., Zine-Eddine F., Poppe A., Fonseca AC., Baptista MF., Cruz D., Romoli M., De Marco G., Longoni M., Keser Z., Griffin KJ., Kuohn L., Frontera JA., Amar JY., Giles JA., Zedde M., Pascarella R., Grisendi I., Nzwalo H., Liebeskind DS., Molaie A., Cavalier A., Kam W., Mac Grory B., Al Kasab S., Anadani M., Kicielinski KP., Eltatawy A., Chervak L., Chulluncuy Rivas R., Aziz YN., Mistry EA., Bakradze E., Tran TL., Rodrigo-Gisbert M., Requena M., Saleh Velez FG., Garcia JO., Muddasani V., de Havenon A., Sanchez S., Vishnu VY., Yaddanapudi S., Adams L., Browngoehl A., Ranasinghe T., Dunston R., Lynch Z., Penckofer M., Siegler JE., Mayer S., Willey JZ., Zubair AS., Cheng YK., Sharma R., Marto JP., Krupka D., Klein P., Nguyen TN., Asad SD., Sarwat Z., Balabhadra A., Patel S., Secchi T., Martins SC., Mantovani GP., Kim YD., Krishnaiah B., Elangovan C., Lingam S., Qureshi AY., Fridman S., Alvarado A., Khasiyev F., Linares G., Mannino M., Terruso V., Tountopoulou A., Tentolouris-Piperas V., Martinez-Marino MM., Carrasco Wall V., Indraswari F., El Jamal SE., Liu S., Zhou M., Alvi MM., Ali F., Sarvath M., Morsi RZ., Kass-Hout T., Shi F., Zhang J., Sokhi D., Said J., Mongare N., Simpkins AN., Gomez R., Sen S., Ghani M., Elnazeir M., Wangqin R., Xiao H., Kala NS., Khan F., Stretz C., Mohammadzadeh N., Goldstein ED., Furie K., Yaghi S.
ObjectivesCervical artery dissection (CeAD) accounts for 25% of ischemic strokes in young adults. This study evaluated the benefits and harms of intravenous thrombolysis (IVT) in patients presenting with spontaneous CeAD and acute ischemic stroke symptoms.MethodsThis 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).ResultsThis 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).DiscussionIn 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 evidenceThis study provides Class III evidence that IVT significantly increases the probability of 90-day functional independence in patients with CeAD.