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Safety and outcomes of intravenous thrombolysis in dissection-related ischemic stroke: an international multicenter study and comprehensive meta-analysis of reported case series

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Abstract

The safety and efficacy of intravenous thrombolysis (IVT) in dissection-related ischemic stroke (DRIS) has not been established. We sought to determine safety and recovery rates of IVT in DRIS using prospective, international, multicenter data and by conducting a comprehensive meta-analysis of reported case series. We analyzed consecutive DRIS patients treated with IVT according to national guidelines during a 5-year period at six tertiary-care stroke centers, and also conducted a comprehensive review and meta-analysis of all available case series reporting safety outcomes in DRIS treated with IVT according to PRISMA guidelines. A total of 39 DRIS patients (mean age 60 ± 18 years; 59 % men; median NIHSS 13 points, IQR 9–17) received IVT in our multicenter study. Symptomatic intracranial hemorrhage (sICH), in-hospital mortality, complete recanalization, favorable functional outcome (FFO; mRS-score of 0–1) and functional independence (FI; mRS-score of 0–2) were 0 % (adjusted Wald 95 % CI 0–8 %), 10 % (3–24 %), 55 % (40–70 %), 61 % (45–74 %) and 68 % (52–81 %). The pooled sICH and mortality rates in meta-analysis including 10 case series (234 IVT-DRIS patients) were 2 % (0–5 %) and 4 % (0–8 %). The pooled recanalization, FFO and FI rates were 45 % (26–67 %), 41 % (29–54 %) and 61 % (48–72 %), respectively. Substantial heterogeneity was only found for FFO (I 2 = 61 %; p = 0.006). Subsequent meta-regression analysis identified baseline NIHSS and dissection in the posterior circulation as independent predictors of FFO (p < 0.05), accounting for FFO variance across different studies. Our prospective, international data coupled with comprehensive meta-analysis results underscore IVT safety in DRIS, while further independent validation is required in larger observational registries or RCTs.

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Acknowledgments

This study has been presented in the International Stroke Conference 2015 (podium presentation). Dr. Georgios Tsivgoulis has been supported by European Regional Development Fund—Project St. Anne´s University Hospital, Brno—International Clinical Research Center (FNUSA-ICRC) (No. CZ.1.05/1.1.00/02.0123).

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Authors and Affiliations

  1. Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA

    Georgios Tsivgoulis, Ramin Zand, Nitin Goyal, Anne W. Alexandrov, Marc D. Malkoff & Andrei V. Alexandrov

  2. Second Department of Neurology, “Attikon University Hospital”, School of Medicine, University of Athens, Iras 39, Gerakas Attikis, 15344, Athens, Greece

    Georgios Tsivgoulis, Aristeidis H. Katsanos & Konstantinos Voumvourakis

  3. Department of Neurology, School of Medicine, Democritus University of Thrace, Alexandroupolis, Greece

    Georgios Tsivgoulis & Konstantinos Vadikolias

  4. International Clinical Research Center, St. Anne’s University Hospital in Brno, Brno, Czech Republic

    Georgios Tsivgoulis

  5. Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore

    Vijay K. Sharma

  6. Department of Neurology, St. Josef-Hospital, Ruhr University, Bochum, Germany

    Christos Krogias

  7. Stroke Unit, Department of Neurology, Brugmann University Hospital, Brussels, Belgium

    Apostolos Safouris

  8. Australian Catholic University, Sydney, Australia

    Anne W. Alexandrov

Authors
  1. Georgios Tsivgoulis
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  2. Ramin Zand
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  3. Aristeidis H. Katsanos
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  9. Konstantinos Voumvourakis
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  10. Anne W. Alexandrov
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  12. Andrei V. Alexandrov
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Corresponding author

Correspondence to Georgios Tsivgoulis.

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Ethical standard

The study was approved by the corresponding institutional ethical standards committees in each participating center.

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Tsivgoulis, G., Zand, R., Katsanos, A.H. et al. Safety and outcomes of intravenous thrombolysis in dissection-related ischemic stroke: an international multicenter study and comprehensive meta-analysis of reported case series. J Neurol 262, 2135–2143 (2015). https://doi.org/10.1007/s00415-015-7829-x

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  • DOI: https://doi.org/10.1007/s00415-015-7829-x

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