Safety of Thrombolysis in Patients with Acute Ischemic Stroke caused by Cervical Artery Dissection—A Review

Zinkstok S M, Nederkoorn P J, Vergouwen M DI.  Safety of Thrombolysis in Patients with Acute Ischemic Stroke Caused by Cervical Artery Disseciton – A Review.  European Neurological Journal, June 2010; 2(1):  65-72

Review article


SM Zinkstok  ¹, PJ Nederkoorn  ¹ and MDI Vergouwen  ²
Affiliations: ¹Department of Neurology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands and ²Division of Neurology, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada


ABSTRACT

Background and purpose. It is unclear whether thrombolysis is safe in patients with dissection‐related ischemic strokes. The purpose of the present study is to review the available literature on this subject.
Methods. We systematically searched the PUBMED and EMBASE databases for all studies and case reports describing thrombolytic treatment in patients with cervical artery dissection (CAD). Studies were assessed on safety, stroke progression, stroke recurrence, and death.
Results. Thirteen retrospective series and 22 case reports comprising 185 patients were identified (intravenous thrombolysis (IVT): n = 144; intra‐arterial thrombolysis (IAT): n = 25; IVT followed by IAT: n = 1; IAT with additional endovascular procedures: n = 15). Complication rates due to IVT were low (intramural hematoma extension 0%, pseudoaneurysm 1.4%, recurrent stroke 1.4%, progressive stroke 0.7%, symptomatic intracranial hemorrhage 3.5%). In patients treated with IAT, either with or without additional interventional procedures, no complications were reported. Mortality was 7% in IVT‐treated patients, 8% in IAT‐treated patients, and 0% in patients who had IAT in combination with other endovascular procedures. Mortality was mostly attributed to initial stroke severity and not to thrombolysis‐related complications.
Conclusion. The results of this review suggest that intravenous thrombolysis in CAD is safe. Currently, there is no evidence to exclude patients suspected of dissection‐related stroke from thrombolytic treatment.

Keywords: ischemic stroke, dissection, thrombolysis, recombinant tissue plasminogen activator (rt‐PA), safety, review
Correspondence: M D I Vergouwen, Division of Neurology, Toronto Western Hospital, University of Toronto, 399 Bathurst Street, 5th Floor West Wing, Room 425, Toronto, Ontario M5T 2S8, Canada. Tel: (1)‐416‐603‐5800, ext. 4468; Fax: (1)‐416‐603‐7733; e‐mail: Mervyn.Vergouwen@uhn.on.ca