Intravenous Thrombolysis in Patients With Cervical Artery Dissection
Liqi Shu, Favour Akpokiere, Daniel Mandel, Thalia S. Field, Christopher R. Leon Guerrero, Nils Henninger, Jayachandra Muppa, Muhammad Affan, Omair ul haq Lodhi, Mirjam R. Heldner, Kateryna Antonenko, David Seiffge, Marcel Arnold, Setareh Salehi Omran, Ross Crandall, Evan Lester, Diego López-Mena, Antonio Araúz, Ahmad Nehme, Marion Boulanger, Emmanuel Touzé, João André Sousa, João Sargento‐Freitas, Vasco Barata, Paulo Castro‐Chaves, Maria T. Brito, Muhib Khan, Dania Mallick, Aaron Rothstein, Ossama Khazaal, Josefin E. Kaufmann, Stefan T. Engelter, Christopher Traenka, Diana Aguiar de Sousa, Mafalda Soares, Sara Rosa, Lily Zhou, Preet Gandhi, Steven Mancini, Issa Metanis, Ronen R. Leker, Kelly Pan, Vishnu Dantu, Karl Baumgartner, Tina Burton, Regina von Rennenberg, Christian H. Nolte, Richard Choi, J Macdonald, Reza Bavarsad Shahripour, Xiaofan Guo, Malik Ghannam, Mohammad Almajali, Edgar A. Samaniego, Bastien Rioux, Fayçal Zine-Eddine, Alexandre Y. Poppe, Ana Catarina Fonseca, Maria Fortuna Baptista, Diana Cruz, Michele Romoli, Giovanna De Marco, Marco Longoni, Zafer Keser, Kim J. Griffin, Lindsey Kuohn, Jennifer Frontera, Jordan Amar, James Giles, Marialuisa Zedde, Rosario Pascarella, Ilaria Grisendi, Hipólito Nzwalo, David S. Liebeskind, Amir Molaie, Annie Cavalier, Wayneho Kam, Brian Mac Grory, Sami Al Kasab, Mohammad Anadani, Kimberly Kicielinski, Ali Eltatawy, Lina Chervak, Roberto Chulluncuy Rivas, Yasmin Aziz, Eva Mistry, Ekaterina Bakradze, Thanh Lam Tran, Marc Rodrigo‐Gisbert, Manuel Requena, Faddi G. Saleh Velez, Jorge Ortiz Garcia, Varsha Muddasani, Adam de Havenon, Sebastian Sanchez, Venugopalan Y. Vishnu, Sridhara Yaddanapudi, L Adams, Abigail Browngoehl, Tamra Ranasinghe
Abstract
OBJECTIVES: Cervical 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. 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: = 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.