Endovascular therapy versus intravenous thrombolysis in cervical artery dissection ischemic stroke - Results from the SWISS registry

被引：28

作者：

Traenka, Christopher ^{[1
,2
,3
]}

Jung, Simon ^{[4
]}

Gralla, Jan ^{[4
,5
]}

Kurmann, Rebekka ^{[4
]}

Stippich, Christoph ^{[2
,6
]}

Simonetti, Barbara Goeggel ^{[4
,7
]}

Gensicke, Henrik ^{[1
,2
,3
,8
]}

Mueller, Hubertus ^{[9
]}

Lovblad, Karl ^{[10
]}

Eskandari, Ashraf ^{[11
]}

Puccinelli, Francesco ^{[12
]}

Vehoff, Jochen ^{[13
]}

Weber, Johannes ^{[14
]}

Wegener, Susanne ^{[15
]}

Steiner, Levke ^{[15
]}

Gi, Georg Ka ^{[13
]}

Luft, Andreas ^{[15
]}

Sztajzel, Roman ^{[9
]}

Fischer, Urs ^{[4
]}

Bonati, Leo H. ^{[1
,2
]}

Peters, Nils ^{[1
,2
,3
,8
]}

Michel, Patrik ^{[11
]}

Lyrer, Philippe A. ^{[1
,2
,3
]}

Arnold, Marcel ^{[4
]}

Engelter, Stefan T. ^{[1
,2
,3
]}

机构：

[1] Univ Basel, Dept Neurol, Petersgraben 4, CH-4031 Basel, Switzerland

[2] Univ Basel, Univ Hosp, Stroke Ctr, Petersgraben 4, CH-4031 Basel, Switzerland

[3] Univ Basel, Univ Hosp, Dept Clin Res, Basel, Switzerland

[4] Univ Bern, Univ Hosp Bern, Dept Neurol, Bern, Switzerland

[5] Univ Bern, Univ Hosp Bern, Dept Diagnost & Intervent Neuroradiol, Bern, Switzerland

[6] Univ Basel, Dept Neuroradiol, Basel, Switzerland

[7] Neuropediat San Giovanni Hosp Bellinzona, Bellinzona, Switzerland

[8] Univ Basel, Univ Ctr Med Aging & Rehabil, Felix Platter Hosp, Neurorehabil Unit, Basel, Switzerland

[9] Geneva Univ Hosp, Dept Neurol, Geneva, Switzerland

[10] Geneva Univ Hosp, Div Neuroradiol, Geneva, Switzerland

[11] Univ Lausanne, Ctr Hosp Univ Vaudois, Stroke Ctr, Neurol Serv, Lausanne, Switzerland

[12] Univ Lausanne, Ctr Hosp Univ Vaudois, Dept Diagnost & Intervent Radiol, Lausanne, Switzerland

[13] Kantonsspital St Gallen, Dept Neurol, Gallen, Switzerland

[14] Kantonsspital St Gallen, Dept Radiol, Div Neuroradiol, Gallen, Switzerland

[15] Univ Hosp Zurich, Dept Neurol, Zurich, Switzerland

来源：

EUROPEAN STROKE JOURNAL | 2018年 / 3卷 / 01期

基金：

瑞士国家科学基金会;

关键词：

Stroke; dissection; thrombolysis; endovascular therapy;

D O I：

10.1177/2396987317748545

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Introduction In patients with stroke attributable to cervical artery dissection, we compared endovascular therapy to intravenous thrombolysis regarding three-month outcome, recanalisation and complications. Materials and methods In a multicentre intravenous thrombolysis/endovascular therapy-register-based cohort study, all consecutive cervical artery dissection patients with intracranial artery occlusion treated within 6h were eligible for analysis. Endovascular therapy patients (with or without prior intravenous thrombolysis) were compared to intravenous thrombolysis patients regarding (i) excellent three-month outcome (modified Rankin Scale score 0-1), (ii) symptomatic intracranial haemorrhage, (iii) recanalisation of the occluded intracranial artery and (iv) death. Upon a systematic literature review, we performed a meta-analysis comparing endovascular therapy to intravenous thrombolysis in cervical artery dissection patients regarding three-month outcome using a random-effects Mantel-Haenszel model. Results Among 62 cervical artery dissection patients (median age 48.8 years), 24 received intravenous thrombolysis and 38 received endovascular therapy. Excellent three-month outcome occurred in 23.7% endovascular therapy and 20.8% with intravenous thrombolysis patients. Symptomatic intracranial haemorrhage occurred solely among endovascular therapy patients (5/38 patients, 13.2%) while four (80%) of these patients had bridging therapy; 6/38 endovascular therapy and 0/24 intravenous thrombolysis patients died. Four of these 6 endovascular therapy patients had bridging therapy. Recanalisation was achieved in 84.2% endovascular therapy patients and 66.7% intravenous thrombolysis patients (odds ratio 3.2, 95% confidence interval [0.9-11.38]). Sensitivity analyses in a subgroup treated within 4.5h revealed a higher recanalisation rate among endovascular therapy patients (odds ratio 3.87, 95% confidence interval [1.00-14.95]), but no change in the key clinical findings. In a meta-analysis across eight studies (n=212 patients), cervical artery dissection patients (110 intravenous thrombolysis and 102 endovascular therapy) showed identical odds for favourable outcome (odds ratio 0.97, 95% confidence interval [0.38-2.44]) among endovascular therapy patients and intravenous thrombolysis patients. Discussion and Conclusion In this cohort study, there was no clear signal of superiority of endovascular therapy over intravenous thrombolysis in cervical artery dissection patients, which - given the limitation of our sample size - does not prove that endovascular therapy in these patients cannot be superior in future studies. The observation that symptomatic intracranial haemorrhage and deaths in the endovascular therapy group occurred predominantly in bridging patients requires further investigation.

引用

页码：47 / 56

页数：10

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