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Abstract

Background

Limited observational data are available on endovascular treatment in acute ischemic stroke due to cervical artery dissection. Three studies comparing endovascular treatment with standard medical therapy or intravenous thrombolysis in cervical artery dissection-related acute ischemic stroke did not demonstrate superiority of endovascular treatment. Efficacy and the choice of endovascular treatment technique in this setting remain to be established.

Aims

To assess the potential efficacy and safety of endovascular treatment compared to intravenous thrombolysis alone or to no revascularization treatment in our center.

Methods

We selected all consecutive patients with cervical artery dissection-related acute ischemic stroke and intracranial occlusion from the Acute STroke Registry and Analysis of Lausanne between 2003 and 2017. We compared clinical and neuroimaging data of patients treated by endovascular treatment versus patients receiving intravenous thrombolysis or patients without revascularization treatment. Safety analysis included symptomatic intracranial hemorrhage, major radiological hemorrhages (parenchymal hematoma 1, parenchymal hematoma 2, and subarachnoid hemorrhage) and mortality within seven days. We assessed favorable clinical outcome (modified Rankin Scale 0-2) at three months using a binary logistic regression model.

Results

Of the 109 patients included, 24 had endovascular treatment, 38 received intravenous thrombolysis alone, and 47 had no revascularization treatment. Endovascular treatment patients had a higher rate of recanalization at 24 h. Major radiological hemorrhages occurred more often in endovascular treatment patients (all with bridging therapy) than in patients without revascularization treatment (p = 0.026), with no differences in symptomatic intracranial hemorrhage or mortality within seven days. Favorable clinical outcome at three months did not differ between groups (endovascular treatment versus intravenous thrombolysis p = 0.407; endovascular treatment versus no revascularization treatment p = 0.580).

Conclusions

In this single-center cohort of cervical artery dissection-related acute ischemic stroke with intracranial occlusion, endovascular treatment with prior intravenous thrombolysis may increase the risk of major radiological but not symptomatic intracranial hemorrhage. Despite the lack of clear superiority in our cohort, endovascular treatment should currently not be withheld in these patients.

Keywords

Cervical artery dissection endovascular treatment acute ischemic stroke intravenous thrombolysis

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References

Engelter

Traenka

Von Hessling

Lyrer

. Diagnosis and treatment of cervical artery dissection. Neurol Clin 2015; 33: 421–441.

National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 1995; 333: 1581–1587.

Hacke

Kaste

Fieschi

et al.

Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II). Lancet 1998; 352: 1245–1251.

Goyal

Demchuk

Menon

et al.

Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med 2015; 372: 1019–1030.

Campbell

Mitchell

Kleinig

et al.

Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med 2015; 372: 1009–1018.

Berkhemer

Fransen

Beumer

et al.

A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 2015; 372: 11–20.

Jovin

Chamorro

Cobo

et al.

Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med 2015; 372: 2296–2306.

Saver

Goyal

Bonafe

et al.

Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med 2015; 372: 2285–2295.

Bracard

Ducrocq

Mas

et al.

Mechanical thrombectomy after intravenous alteplase versus alteplase alone after stroke (THRACE): a randomised controlled trial. Lancet Neurol 2016; 15: 1138–1147.

10.

Engelter

Rutgers

Hatz

et al.

Intravenous thrombolysis in stroke attributable to cervical artery dissection. Stroke 2009; 40: 3772–3776.

11.

Lin

Sun

Zhao

. Safety and efficacy of thrombolysis in cervical artery dissection-related ischemic stroke: a meta-analysis of observational studies. Cerebrovasc Dis 2016; 42: 272–279.

12.

Powers

Rabinstein

Ackerson

et al.

2018 Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals From the American Heart Association/American Stroke Association. Stroke 2018; 49: e46–e110.

13.

Kurre

Bansemir

Aguilar Perez

et al.

Endovascular treatment of acute internal carotid artery dissections: technical considerations, clinical and angiographic outcome. Neuroradiology 2016; 58: 1167–1179.

14.

Haussen

Jadhav

Jovin

et al.

Endovascular management vs intravenous thrombolysis for acute stroke secondary to carotid artery dissection: local experience and systematic review. Neurosurgery 2016; 78: 709–716.

15.

Jensen

Salottolo

Frei

et al.

Comprehensive analysis of intra-arterial treatment for acute ischemic stroke due to cervical artery dissection. J Neurointerv Surg 2017; 9: 654–658.

16.

Hoving

Marquering

Majoie

. Endovascular treatment in patients with carotid artery dissection and intracranial occlusion: a systematic review. Neuroradiology 2017; 59: 641–647.

17.

Traenka

Jung

Gralla

et al.

Endovascular therapy versus intravenous thrombolysis in cervical artery dissection ischemic stroke—results from the SWISS registry. Eur Stroke J 2018; 3: 47–56.

18.

Lavallee

Mazighi

Saint-Maurice

et al.

Stent-assisted endovascular thrombolysis versus intravenous thrombolysis in internal carotid artery dissection with tandem internal carotid and middle cerebral artery occlusion. Stroke 2007; 38: 2270–2274.

19.

Baumgartner

Georgiadis

Nedeltchev

et al.

20.

Mourand

Brunel

Vendrell

Thouvenot

Bonafé

. Endovascular stent-assisted thrombolysis in acute occlusive carotid artery dissection. Neuroradiology 2010; 52: 135–140.

21.

Lekoubou

Cho

Nighoghossian

et al.

Combined intravenous recombinant-tissular plasminogen activator and endovascular treatment of spontaneous occlusive internal carotid dissection with tandem intracranial artery occlusion. Eur Neurol 2010; 63: 211–214.

22.

Scheperjans

Pekkola

Mustanoja

et al.

IV thrombolysis-bridging and endovascular treatment for occlusive internal carotid artery dissection with tandem occlusion. Case Rep Neurol 2012; 4: 13–19.

23.

Fields

Lutsep

Rymer

et al.

Endovascular mechanical thrombectomy for the treatment of acute ischemic stroke due to arterial dissection. Interv Neuroradiol 2012; 18: 74–79.

24.

Cohen

Leker

Eichel

Gomori

Itshayek

. Emergency endovascular revascularization of tandem occlusions: internal carotid artery dissection and intracranial large artery embolism. J Clin Neurosci 2016; 28: 157–161.

25.

Michel

Odier

Rutgers

et al.

The Acute STroke Registry and Analysis of Lausanne (ASTRAL): design and baseline analysis of an ischemic stroke registry including acute multimodal imaging. Stroke 2010; 41: 2491–2498.

26.

Engelter

Dallongeville

Kloss

et al.

Thrombolysis in cervical artery dissection—data from the Cervical Artery Dissection and Ischaemic Stroke Patients (CADISP) database. Eur J Neurol 2012; 19: 1199–1206.

27.

Debette

Grond-Ginsbach

Bodenant

et al.

Differential features of carotid and vertebral artery dissections: the CADISP study. Neurology 2011; 77: 1174–1181.

28.

Vanacker

Lambrou

Eskandari

et al.

Improving prediction of recanalization in acute large-vessel occlusive stroke. J Thromb Haemost 2014; 12: 814–821.

29.

Rotzinger

Mosimann

Meuli

Maeder

Michel

. Site and rate of occlusive disease in cervicocerebral arteries: a CT angiography study of 2209 patients with acute ischemic stroke. AJNR Am J Neuroradiol 2017; 38: 868–874.

30.

Debette

Metso

Pezzini

et al.

Association of vascular risk factors with cervical artery dissection and ischemic stroke in young adults. Circulation 2011; 123: 1537–1544.

31.

Rha

Saver

. The impact of recanalization on ischemic stroke outcome: a meta-analysis. Stroke 2007; 38: 967–973.

32.

Hao

Zhang

et al.

Risk of intracranial hemorrhage after endovascular treatment for acute ischemic stroke: systematic review and meta-analysis. Interv Neurol 2017; 6: 57–64.

33.

Bridging thrombolysis versus direct mechanical thrombectomy in acute ischemic stroke, https://ClinicalTrials.gov/show/NCT03192332 (accessed 21 December 2018).

34.

Fiehler

Cognard

Gallitelli

et al.

European recommendations on organisation of interventional care in acute stroke (EROICAS). Int J Stroke 2016; 11: 701–716.

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Efficacy and safety of endovascular treatment in acute ischemic stroke due to cervical artery dissection: A 15-year consecutive case series

Abstract

Background

Aims

Methods

Results

Conclusions

Keywords

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References

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