Intraarterial Thrombolysis And Endovascular Treatment is Safe and Effective In Patients With Ischemic Stroke Due To Dissection (P5.159)

Abstract

OBJECTIVE: To examine the safety and efficacy of intraarterial and endovascular treatment for acute ischemic stroke (AIS) due to dissection. BACKGROUND: Carotid and vertebral artery dissection should not be considered a contraindication for intravenous tPA treatment. Few studies report safety and efficacy of intraarterial thrombolysis or endovascular treatment for dissection. DESIGN/METHODS: We studied consecutive admissions with AIS to our Comprehensive Stroke Center from 2012-2013 who received intraarterial thrombolysis or an endovascular procedure (“aggressive therapy”). We examined differences in adverse events, defined as in-hospital death and symptomatic ICH (sICH), and favorable outcome, defined as Modified Rankin Score (mRS) ≤2 at discharge and 3 months, for AIS patients who presented with mechanism of dissection vs. other cause. RESULTS: Of 1,320 patients with AIS, 173 patients received aggressive therapy and comprise our study population: 15 with dissection (8.7[percnt]: 11 carotid, 4 vertebral) and 158 without dissection (91.3[percnt]). Stroke severity was similar with vs. without dissection (mean NIHSS: 15.4 vs. 17.2, p=0.29). There were no differences in adverse event rates for patients presenting with vs. without dissection (sICH: 0[percnt] vs. 8.2[percnt], p=0.61; mortality: 20.0[percnt] vs. 18.3[percnt], p=1.0). Notably, no AIS patients with dissection receiving aggressive therapy developed a sICH. There were also no differences in favorable outcome for patients presenting with vs. without dissection (discharge mRS ≤2: 26.7[percnt] vs. 20.4[percnt], p=0.52; 3 month mRS ≤2: 58.3[percnt] vs. 45.1[percnt], p=0.38). There were 3 deaths in patients with dissection: one death resulted from occlusion of a stent placed to treat stenosis caused by dissection. CONCLUSIONS: Aggressive therapy, including intraarterial thrombolysis and endovascular treatment, appears to be as safe and effective when used in patients with ischemic stroke due to dissection as in AIS patients with other causes. It would be difficult to create an ethical randomized trial to evaluate aggressive therapy in this patient population.

Disclosure: Dr. Jensen has nothing to disclose. Dr. Wagner has received personal compensation for activities with Genentech, Inc. Dr. Salottolo has nothing to disclose. Dr. Loy has nothing to disclose. Dr. Bar-Or has nothing to disclose.