دورية أكاديمية
Should Patients With Acute Minor Ischemic Stroke With Isolated Internal Carotid Artery Occlusion Be Thrombolysed?
| العنوان: | Should Patients With Acute Minor Ischemic Stroke With Isolated Internal Carotid Artery Occlusion Be Thrombolysed? |
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| المؤلفون: | Boulenoir, N., Turc, G., Ter Schiphorst, A., Heldner, M.R., Strambo, D., Laksiri, N., Girard Buttaz, I., Papassin, J., Sibon, I., Chausson, N., Michel, P., Rosso, C., Bourdain, F., Lamy, C., Weisenburger-Lile, D., Agius, P., Yger, M., Obadia, M., Sablot, D., Legris, N., Jung, S., Pilgram-Pastor, S., Henon, H., Bernardaud, L., Arquizan, C., Baron, J.C., Seners, P. |
| المساهمون: | ISOCAR and MINOR-STROKE Collaborators, 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. |
| المصدر: | Stroke, vol. 53, no. 11, pp. 3304-3312 |
| سنة النشر: | 2022 |
| المجموعة: | Université de Lausanne (UNIL): Serval - Serveur académique lausannois |
| مصطلحات موضوعية: | Humans, Fibrinolytic Agents/therapeutic use, Thrombolytic Therapy/methods, Ischemic Stroke, Carotid Artery, Internal/diagnostic imaging, Retrospective Studies, Treatment Outcome, Arterial Occlusive Diseases/diagnostic imaging, Arterial Occlusive Diseases/drug therapy, Arterial Occlusive Diseases/complications, Stroke/diagnostic imaging, Stroke/drug therapy, Stroke/etiology, Carotid Artery Diseases/complications, Thrombosis/drug therapy, Anticoagulants/therapeutic use, Brain Ischemia/diagnostic imaging, Brain Ischemia/drug therapy, Brain Ischemia/complications, Thrombectomy/methods, anticoagulant, internal, embolism, thrombus |
| الوصف: | 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 7d ) 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 7d 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 7d and 3-month modified Rankin Scale score of 0 to 1 did not significantly differ between the 2 groups (END 7d : 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 7d occurred earlier in the IVT group: median imaging-to-END 2.6 hours (interquartile range, ... |
| نوع الوثيقة: | article in journal/newspaper |
| اللغة: | English |
| تدمد: | 0039-2499 |
| العلاقة: | info:eu-repo/semantics/altIdentifier/pmid/36073368; info:eu-repo/semantics/altIdentifier/eissn/1524-4628; https://serval.unil.ch/notice/serval:BIB_C90FB2944BD6Test; urn:issn:0039-2499 |
| DOI: | 10.1161/STROKEAHA.122.039228 |
| الإتاحة: | https://doi.org/10.1161/STROKEAHA.122.039228Test https://serval.unil.ch/notice/serval:BIB_C90FB2944BD6Test |
| رقم الانضمام: | edsbas.24482816 |
| قاعدة البيانات: | BASE |
Full Text Finder | تدمد: | 00392499 |
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| DOI: | 10.1161/STROKEAHA.122.039228 |