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Intravenous thrombolysis in acute ischemic stroke due to intracranial artery dissection: a single-center case series and a review of literature

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Abstract

Efficacy and safety of intravenous thrombolysis (IVT) in acute ischemic stroke (AIS) due to intracranial artery dissection (IAD) are currently not established. We aimed to present a single-center experience on IAD-related AIS treated by IVT. We selected all consecutive patients with IAD-related AIS treated by IVT from a prospectively constructed single-center acute stroke registry from 2003 to 2017. We reviewed demographical, clinical and neuroimaging data and recorded hemorrhagic complications, mortality within 7 days and modified Rankin Scale at 3-months. Out of 181 AISs related to cervicocephalic dissections, 10 (5.5%) were due to IAD and five of these patients received IVT. Among these five patients, median age was 62 years; hypertension and dyslipidemia were the most frequent vascular risk factors. IAD locations were distal internal carotid artery, middle cerebral artery (M1), anterior cerebral artery (A2), and, in two cases, the basilar artery. All anterior circulation IADs were occlusive or subocclusive, while the two basilar artery IADs caused arterial stenosis. After IVT, there were no subarachnoid or symptomatic intracranial hemorrhages. One patient had an asymptomatic hemorrhagic infarct type 1. Two patients died within 7 days from ischemic mass effect. The other three patients had favorable clinical outcomes at 3-months. In this small single-center case series of IAD-related AIS, thrombolysis seemed relatively safe. However, IVT efficacy and the likelihood of arterial recanalization are still uncertain in this context. Further studies are needed to assess the safety and efficacy of IVT in these patients.

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Acknowledgements

Melanie Price Hirt for English language correction and editing.

Funding

No funding was received for this study.

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Authors and Affiliations

  1. Stroke Center, Neurology Service, Lausanne University Hospital, Rue du Bugnon 46, 1011, Lausanne, Switzerland

    Francisco Bernardo, Stefania Nannoni, Davide Strambo, Patrik Michel & Gaia Sirimarco

  2. Department of Neurology, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal

    Francisco Bernardo

  3. Interventional Neuroradiology Unit, Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland

    Bruno Bartolini

Authors
  1. Francisco Bernardo
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  2. Stefania Nannoni
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  3. Davide Strambo
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  4. Bruno Bartolini
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  5. Patrik Michel
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  6. Gaia Sirimarco
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Correspondence to Francisco Bernardo.

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Conflict of interest

P Michel: research grants (Swiss Heart Foundation, Boehringer-Ingelheim, and BMS); speaker fees (Boehringer-Ingelheim, Bayer, Daiichi-Sankyo, and Medtronic); consulting fees (Medtronic), and honoraria from scientific advisory boards (Boehringer-Ingelheim, Pfizer and BMS). All used for education and research. G. Sirimarco: research grant (Swiss Heart Foundation), congress travel support (Bayer and Shire), and served on scientific advisory boards (Amgen and Daiichi-Sankyo). All fees are paid to her institution. Other authors declare no conflicts of interest.

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This study was based on a registry approved by local ethics committee.

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Informed consent was obtained from all individual participants included in the study.

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Bernardo, F., Nannoni, S., Strambo, D. et al. Intravenous thrombolysis in acute ischemic stroke due to intracranial artery dissection: a single-center case series and a review of literature. J Thromb Thrombolysis 48, 679–684 (2019). https://doi.org/10.1007/s11239-019-01918-6

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  • DOI: https://doi.org/10.1007/s11239-019-01918-6

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