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.
View at publisher
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.
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.
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.
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.
179 downloads since deposited on 07 Jan 2012
58 downloads since 12 months
|Item Type:||Journal Article, refereed, further contribution|
|Communities & Collections:||04 Faculty of Medicine > University Hospital Zurich > Clinic for Neurology|
|Dewey Decimal Classification:||610 Medicine & health|
|Deposited On:||07 Jan 2012 22:05|
|Last Modified:||20 Jan 2014 05:08|
|Publisher:||Lippincott Wiliams & Wilkins|
Users (please log in): suggest update or correction for this item
Repository Staff Only: item control page