Titre
Should Patients With Acute Minor Ischemic Stroke With Isolated Internal Carotid Artery Occlusion Be Thrombolysed?
Type
article
Institution
UNIL/CHUV/Unisanté + institutions partenaires
Périodique
Auteur(s)
Boulenoir, N.
Auteure/Auteur
Turc, G.
Auteure/Auteur
Ter Schiphorst, A.
Auteure/Auteur
Heldner, M.R.
Auteure/Auteur
Strambo, D.
Auteure/Auteur
Laksiri, N.
Auteure/Auteur
Girard Buttaz, I.
Auteure/Auteur
Papassin, J.
Auteure/Auteur
Sibon, I.
Auteure/Auteur
Chausson, N.
Auteure/Auteur
Michel, P.
Auteure/Auteur
Rosso, C.
Auteure/Auteur
Bourdain, F.
Auteure/Auteur
Lamy, C.
Auteure/Auteur
Weisenburger-Lile, D.
Auteure/Auteur
Agius, P.
Auteure/Auteur
Yger, M.
Auteure/Auteur
Obadia, M.
Auteure/Auteur
Sablot, D.
Auteure/Auteur
Legris, N.
Auteure/Auteur
Jung, S.
Auteure/Auteur
Pilgram-Pastor, S.
Auteure/Auteur
Henon, H.
Auteure/Auteur
Bernardaud, L.
Auteure/Auteur
Arquizan, C.
Auteure/Auteur
Baron, J.C.
Auteure/Auteur
Seners, P.
Auteure/Auteur
Contributrices/contributeurs
Ben Hassen, W.
Lapergue, B.
Lucas, L.
Leys, D.
Philippeau, F.
Bennani, O.
Mechtouff, L.
Klapczynski, F.
Detante, O.
Costalat, V.
Mione, G.
Gazzola, S.
Debiais, S.
Cakmak, S.
Grigoras, V.
Denier, C.
Smadja, D.
Mounier-Vehier, F.
Peres, R.
Spelle, L.
Bricout, N.
Bracard, S.
Triquenot, A.
Lyoubi, A.
Cottier, J.P.
Duong, D.L.
Ollivier, C.
Groupes de travail
ISOCAR and MINOR-STROKE Collaborators
Liens vers les personnes
Liens vers les unités
ISSN
1524-4628
Statut éditorial
Publié
Date de publication
2022-11
Volume
53
Numéro
11
Première page
3304
Dernière page/numéro d’article
3312
Peer-reviewed
Oui
Langue
anglais
Notes
Publication types: Multicenter Study ; Journal Article
Publication Status: ppublish
Publication Status: ppublish
Résumé
We recently reported a worrying 30% rate of early neurological deterioration (END) occurring within 24 hours following intravenous thrombolysis (IVT) in minor stroke with isolated internal carotid artery occlusion (ie, without additional intracranial occlusion), mainly due to artery-to-artery embolism. Here, we hypothesize that in this setting IVT-as compared to no-IVT-may foster END, in particular by favoring artery-to-artery embolism from thrombus fragmentation.
From a large multicenter retrospective database, we compared minor stroke (National Institutes of Health Stroke Scale score <6) isolated internal carotid artery occlusion patients treated within 4.5 hours of symptoms onset with either IVT or antithrombotic therapy between 2006 and 2020 (inclusion date varied among centers). Primary outcome was END within 24 hours (≥4 National Institutes of Health Stroke Scale points increase within 24 hours), and secondary outcomes were END within 7 days (END <sub>7d</sub> ) and 3-month modified Rankin Scale score 0 to 1.
Overall, 189 patients were included (IVT=95; antithrombotics=94 [antiplatelets, n=58, anticoagulants, n=36]) from 34 centers. END within 24 hours and END <sub>7d</sub> occurred in 46 (24%) and 60 (32%) patients, respectively. Baseline clinical and radiological variables were similar between the 2 groups, except significantly higher National Institutes of Health Stroke Scale (median 3 versus 2) and shorter onset-to-imaging (124 versus 149min) in the IVT group. END within 24 hours was more frequent following IVT (33% versus 16%, adjusted hazard ratio, 2.01 [95% CI, 1.07-3.92]; P=0.03), driven by higher odds of artery-to-artery embolism (20% versus 9%, P=0.09). However, END <sub>7d</sub> and 3-month modified Rankin Scale score of 0 to 1 did not significantly differ between the 2 groups (END <sub>7d</sub> : adjusted hazard ratio, 1.29 [95% CI, 0.75-2.23]; P=0.37; modified Rankin Scale score of 0-1: adjusted odds ratio, 1.1 [95% CI, 0.6-2.2]; P=0.71). END <sub>7d</sub> occurred earlier in the IVT group: median imaging-to-END 2.6 hours (interquartile range, 1.9-10.1) versus 20.4 hours (interquartile range, 7.8-34.4), respectively, P<0.01.
In our population of minor strokes with iICAO, although END rate at 7 days and 3-month outcome were similar between the 2 groups, END-particularly END due to artery-to-artery embolism-occurred earlier following IVT. Prospective studies are warranted to further clarify the benefit/risk profile of IVT in this population.
From a large multicenter retrospective database, we compared minor stroke (National Institutes of Health Stroke Scale score <6) isolated internal carotid artery occlusion patients treated within 4.5 hours of symptoms onset with either IVT or antithrombotic therapy between 2006 and 2020 (inclusion date varied among centers). Primary outcome was END within 24 hours (≥4 National Institutes of Health Stroke Scale points increase within 24 hours), and secondary outcomes were END within 7 days (END <sub>7d</sub> ) and 3-month modified Rankin Scale score 0 to 1.
Overall, 189 patients were included (IVT=95; antithrombotics=94 [antiplatelets, n=58, anticoagulants, n=36]) from 34 centers. END within 24 hours and END <sub>7d</sub> occurred in 46 (24%) and 60 (32%) patients, respectively. Baseline clinical and radiological variables were similar between the 2 groups, except significantly higher National Institutes of Health Stroke Scale (median 3 versus 2) and shorter onset-to-imaging (124 versus 149min) in the IVT group. END within 24 hours was more frequent following IVT (33% versus 16%, adjusted hazard ratio, 2.01 [95% CI, 1.07-3.92]; P=0.03), driven by higher odds of artery-to-artery embolism (20% versus 9%, P=0.09). However, END <sub>7d</sub> and 3-month modified Rankin Scale score of 0 to 1 did not significantly differ between the 2 groups (END <sub>7d</sub> : adjusted hazard ratio, 1.29 [95% CI, 0.75-2.23]; P=0.37; modified Rankin Scale score of 0-1: adjusted odds ratio, 1.1 [95% CI, 0.6-2.2]; P=0.71). END <sub>7d</sub> occurred earlier in the IVT group: median imaging-to-END 2.6 hours (interquartile range, 1.9-10.1) versus 20.4 hours (interquartile range, 7.8-34.4), respectively, P<0.01.
In our population of minor strokes with iICAO, although END rate at 7 days and 3-month outcome were similar between the 2 groups, END-particularly END due to artery-to-artery embolism-occurred earlier following IVT. Prospective studies are warranted to further clarify the benefit/risk profile of IVT in this population.
Sujets
PID Serval
serval:BIB_C90FB2944BD6
PMID
Date de création
2022-09-20T12:45:17.293Z
Date de création dans IRIS
2025-05-20T21:49:13Z