Advertisement

Intravenous thrombolysis in acute ischemic stroke due to intracranial artery dissection: a single-center case series and a review of literature

  • Francisco BernardoEmail author
  • Stefania Nannoni
  • Davide Strambo
  • Bruno Bartolini
  • Patrik Michel
  • Gaia Sirimarco
Article

Abstract

Efficacy and safety of intravenous thrombolysis (IVT) in acute ischemic stroke (AIS) due to intracranial artery dissection (IAD) are currently not established. We aimed to present a single-center experience on IAD-related AIS treated by IVT. We selected all consecutive patients with IAD-related AIS treated by IVT from a prospectively constructed single-center acute stroke registry from 2003 to 2017. We reviewed demographical, clinical and neuroimaging data and recorded hemorrhagic complications, mortality within 7 days and modified Rankin Scale at 3-months. Out of 181 AISs related to cervicocephalic dissections, 10 (5.5%) were due to IAD and five of these patients received IVT. Among these five patients, median age was 62 years; hypertension and dyslipidemia were the most frequent vascular risk factors. IAD locations were distal internal carotid artery, middle cerebral artery (M1), anterior cerebral artery (A2), and, in two cases, the basilar artery. All anterior circulation IADs were occlusive or subocclusive, while the two basilar artery IADs caused arterial stenosis. After IVT, there were no subarachnoid or symptomatic intracranial hemorrhages. One patient had an asymptomatic hemorrhagic infarct type 1. Two patients died within 7 days from ischemic mass effect. The other three patients had favorable clinical outcomes at 3-months. In this small single-center case series of IAD-related AIS, thrombolysis seemed relatively safe. However, IVT efficacy and the likelihood of arterial recanalization are still uncertain in this context. Further studies are needed to assess the safety and efficacy of IVT in these patients.

Keywords

Intracranial artery dissection Acute ischemic stroke Intravenous thrombolysis rtPA 

Notes

Acknowledgements

Melanie Price Hirt for English language correction and editing.

Funding

No funding was received for this study.

Compliance with ethical standards

Conflict of interest

P Michel: research grants (Swiss Heart Foundation, Boehringer-Ingelheim, and BMS); speaker fees (Boehringer-Ingelheim, Bayer, Daiichi-Sankyo, and Medtronic); consulting fees (Medtronic), and honoraria from scientific advisory boards (Boehringer-Ingelheim, Pfizer and BMS). All used for education and research. G. Sirimarco: research grant (Swiss Heart Foundation), congress travel support (Bayer and Shire), and served on scientific advisory boards (Amgen and Daiichi-Sankyo). All fees are paid to her institution. Other authors declare no conflicts of interest.

Ethical approval

This study was based on a registry approved by local ethics committee.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

11239_2019_1918_MOESM1_ESM.docx (16 kb)
Supplementary material 1 (DOCX 15 kb)

References

  1. 1.
    Sikkema T et al (2014) Intracranial artery dissection. Eur J Neurol 21(6):820–826CrossRefGoogle Scholar
  2. 2.
    Debette S et al (2015) Epidemiology, pathophysiology, diagnosis, and management of intracranial artery dissection. Lancet Neurol 14(6):640–654CrossRefGoogle Scholar
  3. 3.
    Chen H et al (2015) Intracranial versus extracranial artery dissection cases presenting with ischemic stroke. J Stroke Cerebrovasc Dis 24(4):852–859CrossRefGoogle Scholar
  4. 4.
    Fujimoto M et al (2013) Direct thrombus aspiration using the Penumbra system for the treatment of pediatric intracranial dissection. J Neurointerv Surg 5(6):e43CrossRefGoogle Scholar
  5. 5.
    Doijiri R et al (2012) Intravenous recombinant tissue plasminogen activator thrombolysis in acute ischemic stroke due to middle cerebral artery dissection. J Stroke Cerebrovasc Dis 21(8):915e7–915e9CrossRefGoogle Scholar
  6. 6.
    Zinkstok SM et al (2011) Safety and functional outcome of thrombolysis in dissection-related ischemic stroke: a meta-analysis of individual patient data. Stroke 42(9):2515–2520CrossRefGoogle Scholar
  7. 7.
    Tsivgoulis G, Safouris A, Alexandrov AV (2015) Safety of intravenous thrombolysis for acute ischemic stroke in specific conditions. Expert Opin Drug Saf 14(6):845–864CrossRefGoogle Scholar
  8. 8.
    Powers WJ et al (2018) 2018 guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 49(3):e46–e110CrossRefGoogle Scholar
  9. 9.
    Leistner S et al (2001) Successful thrombolytic treatment of intracranial carotid occlusion due to dissection. Eur Neurol 45(4):284–285CrossRefGoogle Scholar
  10. 10.
    Moon Y et al (2012) Intravenous thrombolysis in a patient with acute ischemic stroke attributable to intracranial dissection. Neurologist 18(3):136–138CrossRefGoogle Scholar
  11. 11.
    Arakawa S et al (2017) Thrombolytic therapy for acute ischemic stroke following intracranial artery dissection: fukuoka stroke registry. J Neurol Sci 381:394–395CrossRefGoogle Scholar
  12. 12.
    Shea KEA. Endovascular treatment of ischemic stroke due to intracranial dissection. http://www.svin.org/files/Abstract_2.pdf. Accessed 1 June 2019
  13. 13.
    Hacke W et al (1998) Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II). Second European-Australasian Acute Stroke Study Investigators. Lancet 352(9136):1245–1251CrossRefGoogle Scholar
  14. 14.
    Yoshimoto Y, Wakai S (1997) Unruptured intracranial vertebral artery dissection. Clinical course and serial radiographic imagings. Stroke 28(2):370–374CrossRefGoogle Scholar
  15. 15.
    Kim BM et al (2011) Outcomes and prognostic factors of intracranial unruptured vertebrobasilar artery dissection. Neurology 76(20):1735–1741CrossRefGoogle Scholar
  16. 16.
    Labeyrie MA et al (2018) Prevalence and treatment of spontaneous intracranial artery dissections in patients with acute stroke due to intracranial large vessel occlusion. J Neurointerv Surg 10(8):761–764CrossRefGoogle Scholar
  17. 17.
    Kim DJ et al (2015) Self-expanding stent placement for anterior circulation intracranial artery dissection presenting with ischemic symptoms. Neurosurgery 76(2):158–164 (discussion 164) CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Stroke Center, Neurology ServiceLausanne University HospitalLausanneSwitzerland
  2. 2.Department of NeurologyHospital Professor Doutor Fernando FonsecaAmadoraPortugal
  3. 3.Interventional Neuroradiology Unit, Department of Diagnostic and Interventional RadiologyLausanne University HospitalLausanneSwitzerland

Personalised recommendations