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Thrombolysis in Patients With Acute Stroke Caused by Cervical Artery Dissection
Analysis of 9 Patients and Review of the Literature
Marcel Arnold, MD;
Krassen Nedeltchev, MD;
Matthias Sturzenegger, MD;
Gerhard Schroth, MD;
Thomas J. Loher, MD;
Frank Stepper, MD;
Luca Remonda, MD;
Claudio Bassetti, MD;
Heinrich P. Mattle, MD
Arch Neurol. 2002;59:549-553.
Background Results of recently published studies suggest that intravenous thrombolysis
(IVT) and local intra-arterial thrombolysis (LIT) are feasible procedures
in acute stroke after cervical artery dissection (CAD).
Objectives To describe 9 patients with acute stroke caused by CAD who were treated
by LIT (n = 7) or IVT (n = 2) and to review the literature.
Methods Retrospective analysis of clinical and neuroradiological findings; literature
review from 1980 to present.
Main Outcome Measure Modified Rankin Scale (mRS) score.
Results Of 7 patients treated with LIT, 3 had good outcomes (mRS score of 0-2)
and 4 had bad outcomes (mRS score of 3-6) at 3 months. The 2 patients who
had received IVT recovered to mRS scores of 0 and 3. Twenty-one patients were
identified in the literature. Overall (N = 30), in the IVT group (n = 19),
the outcome was good in 8 patients (42%) and bad in 11 (58%); in the LIT group
(n = 11), 6 patients (55%) had a good outcome and 5 (45%) had a bad outcome.
Overall, 47% (14/30) of the patients (IVT and LIT groups) had a good outcome.
Total mortality was 13% (4/30). There were no secondary complications due
to extension of wall hematoma or angiography. One symptomatic hemorrhage occurred.
Conclusions Thrombolysis is feasible in acute stroke caused by CAD. Local complications
from extension of wall hematoma did not occur. Further prospective studies
are needed to determine the safety and efficacy of thrombolysis in the special
circumstance of acute stroke caused by CAD.
From the Departments of Neurology (Drs Arnold, Nedeltchev, Sturzenegger,
Schroth, Loher, Stepper, Bassetti, and Mattle) and Neuroradiology (Dr Remonda),
University of Berne, Berne, Switzerland.
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