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Permanent URL to this publication: http://dx.doi.org/10.5167/uzh-51008

Zinkstok, S M; Vergouwen, M D I; Engelter, S T; Lyrer, P A; Bonati, L H; Arnold, M; Mattle, H P; Fischer, U; Sarikaya, H; Baumgartner, R W; Georgiadis, D; Odier, C; Michel, P; Putaala, J; Griebenow, M; Wahlgren, N; Ahmed, N; van Geloven, N; de Haan, R J; Nederkoorn, P J (2011). Safety and functional outcome of thrombolysis in dissection-related ischemic stroke: a meta-analysis of individual patient data. Stroke, 42(9):2515-2520.

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Abstract

BACKGROUND AND PURPOSE:
The safety and efficacy of thrombolysis in cervical artery dissection (CAD) are controversial. The aim of this meta-analysis was to pool all individual patient data and provide a valid estimate of safety and outcome of thrombolysis in CAD.
METHODS:
We performed a systematic literature search on intravenous and intra-arterial thrombolysis in CAD. We calculated the rates of pooled symptomatic intracranial hemorrhage and mortality and indirectly compared them with matched controls from the Safe Implementation of Thrombolysis in Stroke-International Stroke Thrombolysis Register. We applied multivariate regression models to identify predictors of excellent (modified Rankin Scale=0 to 1) and favorable (modified Rankin Scale=0 to 2) outcome.
RESULTS:
We obtained individual patient data of 180 patients from 14 retrospective series and 22 case reports. Patients were predominantly female (68%), with a mean±SD age of 46±11 years. Most patients presented with severe stroke (median National Institutes of Health Stroke Scale score=16). Treatment was intravenous thrombolysis in 67% and intra-arterial thrombolysis in 33%. Median follow-up was 3 months. The pooled symptomatic intracranial hemorrhage rate was 3.1% (95% CI, 1.3 to 7.2). Overall mortality was 8.1% (95% CI, 4.9 to 13.2), and 41.0% (95% CI, 31.4 to 51.4) had an excellent outcome. Stroke severity was a strong predictor of outcome. Overlapping confidence intervals of end points indicated no relevant differences with matched controls from the Safe Implementation of Thrombolysis in Stroke-International Stroke Thrombolysis Register.
CONCLUSIONS:
Safety and outcome of thrombolysis in patients with CAD-related stroke appear similar to those for stroke from all causes. Based on our findings, thrombolysis should not be withheld in patients with CAD.

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30 citations in Web of Science®
35 citations in Scopus®
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Additional indexing

Item Type:Journal Article, refereed, further contribution
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Neurology
DDC:610 Medicine & health
Language:English
Date:2011
Deposited On:07 Jan 2012 22:05
Last Modified:20 Jan 2014 05:08
Publisher:Lippincott Wiliams & Wilkins
ISSN:0039-2499
Publisher DOI:10.1161/STROKEAHA.111.617282
PubMed ID:21799165

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