Stroke Units and Department of Neurology, University Hospitals Basel, Switzerland.
Stroke. 2009 Dec;40(12):3772-6. doi: 10.1161/STROKEAHA.109.555953. Epub 2009 Oct 15.
Intravenous thrombolysis (IVT) for stroke seems to be beneficial independent of the underlying etiology. Whether this is also true for cervical artery dissection (CAD) is addressed in this study.
We used the Swiss IVT databank to compare outcome and complications of IVT-treated patients with CAD with IVT-treated patients with other etiologies (non-CAD patients). Main outcome and complication measures were favorable 3-month outcome, intracranial cerebral hemorrhage, and recurrent ischemic stroke. Modified Rankin Scale score <or=1 at 3 months was considered favorable.
Fifty-five (5.2%) of 1062 IVT-treated patients had CAD. Patients with CAD were younger (median age 50 versus 70 years) but had similar median National Institutes of Health Stroke Scale scores (14 versus 13) and time to treatment (152.5 versus 156 minutes) as non-CAD patients. In the CAD group, 36% (20 of 55) had a favorable 3-month outcome compared with 44% (447 of 1007) non-CAD patients (OR, 0.72; 95% CI, 0.41 to 1.26), which was less favorable after adjustment for age, gender, and National Institutes of Health Stroke Scale score (OR, 0.50; 95% CI, 0.27 to 0.95; P=0.03). Intracranial cerebral hemorrhages (asymptomatic, symptomatic, fatal) were equally frequent in CAD (14% [7%, 7%, 2%]) and non-CAD patients (14% [9%, 5%, 2%]; P=0.99). Recurrent ischemic stroke occurred in 1.8% of patients with CAD and in 3.7% of non-CAD-patients (P=0.71).
IVT-treated patients with CAD do not recover as well as IVT-treated non-CAD patients. However, intracranial bleedings and recurrent ischemic strokes were equally frequent in both groups. They do not account for different outcomes and indicate that IVT should not be excluded in patients who may have CAD. Hemodynamic compromise or frequent tandem occlusions might explain the less favorable outcome of patients with CAD.
静脉溶栓（IVT）治疗脑卒中似乎是有益的，与潜在病因无关。本研究旨在探讨这一结论是否同样适用于颈动脉夹层（CAD）患者。
我们使用瑞士 IVT 数据库，比较了 CAD 患者和其他病因（非 CAD 患者）IVT 治疗患者的预后和并发症。主要预后和并发症指标为 3 个月时的良好预后、颅内脑出血和复发性缺血性卒中。3 个月时改良 Rankin 量表评分≤1 被认为是良好预后。
1062 例 IVT 治疗患者中，55 例（5.2%）为 CAD。CAD 患者年龄较小（中位数 50 岁，而非 CAD 患者为 70 岁），但 NIHSS 评分（中位数 14 分与 13 分）和治疗时间（152.5 分钟与 156 分钟）相似。在 CAD 组中，36%（20/55）患者 3 个月预后良好，而非 CAD 患者为 44%（447/1007）（OR，0.72；95%CI，0.411.26），调整年龄、性别和 NIHSS 评分后更差（OR，0.50；95%CI，0.270.95；P=0.03）。CAD 患者（无症状性、症状性、致死性）和非 CAD 患者颅内脑出血（14%[9%、5%、2%]）发生率相同（14%[14%、9%、5%；P=0.99]）。CAD 患者复发性缺血性卒中发生率为 1.8%，而非 CAD 患者为 3.7%（P=0.71）。
IVT 治疗的 CAD 患者的恢复情况不如 IVT 治疗的非 CAD 患者。然而，两组颅内出血和复发性缺血性卒中的发生率相同。这些并发症不能解释两组预后的差异，提示对于可能患有 CAD 的患者，IVT 不应被排除。血流动力学障碍或频繁的串联闭塞可能解释了 CAD 患者预后较差的原因。
