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Systemic Thrombolysis in Patients With Acute Ischemic Stroke and Internal Carotid ARtery Occlusion

2011; Lippincott Williams & Wilkins; Volume: 43; Issue: 1 Linguagem: Inglês

10.1161/strokeaha.111.630624

1524-4628

Maurizio Paciaroni, Clotilde Balucani, Giancarlo Agnelli, Valeria Caso, Giorgio Silvestrelli, James C. Grotta, Andrew M. Demchuk, Sung‐Il Sohn, Giovanni Orlandi, Didier Leys, Alessandro Pezzini, Andrei V. Alexandrov, Mauro Silvestrini, Luisa Fofi, Kristian Barlinn, Domenico Inzitari, Carlo Ferrarese, Rossana Tassi, Georgios Tsivgoulis, Domenico Consoli, Antonio Baldi, Paolo Bovi, E. Luda, Giampiero Galletti, Paolo Invernizzi, Maria Luisa DeLodovici, Francesco Corea, Massimo Del Sette, Serena Monaco, Simona Marcheselli, Andrea Alberti, Michele Venti, Monica Acciarresi, Cataldo D’Amore, Federica Macellari, Alessia Lanari, Paolo Previdi, Nicole R. Gonzales, Renganayaki Pandurengan, Farhaan Vahidy, M. Rick Sline, Simerpreet Bal, Alberto Chiti, Gino Gialdini, Frédéric Dumont, Charlotte Cordonnier, Stéphanie Debette, Alessandro Padovani, Raffaella Cerqua, Ulf Bodechtel, Jessica Kepplinger, Mascia Nesi, Patrizia Nencini, Simone Beretta, Claudia Trentini, Giuseppe Martini, Charitomeni Piperidou, Ioannis Heliopoulos, Sebastiano D’Anna, Manuel Cappellari, E Donati, Giorgio Bono, E Traverso, Danilo Toni,

Traumatic Brain Injury and Neurovascular Disturbances

Background and Purpose— The beneficial effect of intravenous thrombolytic therapy in patients with acute ischemic stroke attributable to internal carotid artery (ICA) occlusion remains unclear. The aim of this study was to evaluate the efficacy and safety of intravenous recombinant tissue-type plasminogen activator in these patients. Methods— ICARO was a case-control multicenter study on prospectively collected data. Patients with acute ischemic stroke and ICA occlusion treated with intravenous recombinant tissue-type plasminogen activator within 4.5 hours from symptom onset (cases) were compared to matched patients with acute stroke and ICA occlusion not treated with recombinant tissue-type plasminogen activator (controls). Cases and controls were matched for age, gender, and stroke severity. The efficacy outcome was disability at 90 days assessed by the modified Rankin Scale, dichotomized as favorable (score of 0–2) or unfavorable (score of 3–6). Safety outcomes were death and any intracranial bleeding. Results— Included in the analysis were 253 cases and 253 controls. Seventy-three cases (28.9%) had a favorable outcome as compared with 52 controls (20.6%; adjusted odds ratio (OR), 1.80; 95% confidence interval [CI], 1.03–3.15; P =0.037). A total of 104 patients died, 65 cases (25.7%) and 39 controls (15.4%; adjusted OR, 2.28; 95% CI, 1.36–3.22; P =0.001). There were more fatal bleedings (2.8% versus 0.4%; OR, 7.17; 95% CI, 0.87–58.71; P =0.068) in the cases than in the controls. Conclusions— In patients with stroke attributable to ICA occlusion, thrombolytic therapy results in a significant reduction in the proportion of patients dependent in activities of daily living. Increases in death and any intracranial bleeding were the trade-offs for this clinical benefit.