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Intravenous Thrombolysis in Patients With Cervical Artery Dissection: A Secondary Analysis of the STOP-CAD Study.

Publication ,  Journal Article
Shu, L; Akpokiere, F; Mandel, DM; Field, TS; Leon Guerrero, CR; Henninger, N; Muppa, J; Affan, M; Haq Lodhi, OU; Heldner, MR; Antonenko, K ...
Published in: Neurology
October 8, 2024
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OBJECTIVES: Cervical artery dissection (CeAD) accounts for 25% of ischemic strokes in young adults. This study evaluated the benefits and harms of intravenous thrombolysis (IVT) in patients presenting with spontaneous CeAD and acute ischemic stroke symptoms. METHODS: This analysis used data from the retrospective STOP-CAD study and included patients with spontaneous CeAD who presented within 1 day of acute ischemic stroke symptoms. Patients were dichotomized into those who received IVT and those managed without IVT. We assessed the association between IVT and 90-day functional independence (modified Rankin Scale scores 0-2) and the incidence of symptomatic intracranial hemorrhage (ICH, defined as ICH causing new or worsening neurologic symptoms within 72 hours after CeAD diagnosis). RESULTS: This study included 1,653 patients from the original STOP-CAD cohort of 4,023. The median age was 49 years, and 35.1% were women; 512 (31.0%) received IVT. IVT was associated with 90-day functional independence (adjusted odds ratio [aOR] = 1.67, 95% CI 1.23-2.28, p = 0.001), but not with symptomatic ICH (aOR = 1.52, 95% CI 0.79-2.92, p = 0.215). DISCUSSION: In patients with spontaneous CeAD and suspected ischemic stroke, IVT improved functional outcomes, without increasing symptomatic ICH risk. These findings support current guideline recommendations to consider thrombolysis for otherwise eligible patients with CeAD. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that IVT significantly increases the probability of 90-day functional independence in patients with CeAD.

Duke Scholars

Wayneho Kam
Author Wayneho Kam Hospital Neurology
Brian C. Mac Grory
Author Brian C. Mac Grory Neurology, Stroke and Vascular Neurology
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Published In

Neurology

DOI

10.1212/WNL.0000000000209843

EISSN

1526-632X

Publication Date

October 8, 2024

Volume

103

Issue

7

Start / End Page

e209843

Location

United States

Related Subject Headings

  • Vertebral Artery Dissection
  • Treatment Outcome
  • Tissue Plasminogen Activator
  • Thrombolytic Therapy
  • Retrospective Studies
  • Neurology & Neurosurgery
  • Middle Aged
  • Male
  • Ischemic Stroke
  • Intracranial Hemorrhages
 

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Shu, L., Akpokiere, F., Mandel, D. M., Field, T. S., Leon Guerrero, C. R., Henninger, N., … Yaghi, S. (2024). Intravenous Thrombolysis in Patients With Cervical Artery Dissection: A Secondary Analysis of the STOP-CAD Study. Neurology, 103(7), e209843. https://doi.org/10.1212/WNL.0000000000209843
Shu, Liqi, Favour Akpokiere, Daniel M. Mandel, Thalia S. Field, Christopher R. Leon Guerrero, Nils Henninger, Jayachandra Muppa, et al. “Intravenous Thrombolysis in Patients With Cervical Artery Dissection: A Secondary Analysis of the STOP-CAD Study.” Neurology 103, no. 7 (October 8, 2024): e209843. https://doi.org/10.1212/WNL.0000000000209843.
Shu L, Akpokiere F, Mandel DM, Field TS, Leon Guerrero CR, Henninger N, et al. Intravenous Thrombolysis in Patients With Cervical Artery Dissection: A Secondary Analysis of the STOP-CAD Study. Neurology. 2024 Oct 8;103(7):e209843.
Shu, Liqi, et al. “Intravenous Thrombolysis in Patients With Cervical Artery Dissection: A Secondary Analysis of the STOP-CAD Study.” Neurology, vol. 103, no. 7, Oct. 2024, p. e209843. Pubmed, doi:10.1212/WNL.0000000000209843.
Shu L, Akpokiere F, Mandel DM, Field TS, Leon Guerrero CR, Henninger N, Muppa J, Affan M, Haq Lodhi OU, Heldner MR, Antonenko K, Seiffge DJ, Arnold M, Salehi Omran S, Crandall R, Lester E, López-Mena D, Arauz A, Nehme A, Boulanger M, Touzé E, Sousa JA, Sargento-Freitas J, Barata V, Castro-Chaves P, Brito MT, Khan M, Mallick D, Rothstein A, Khazaal O, Kaufmann JE, Engelter ST, Traenka C, Aguiar de Sousa D, Soares MD, Rosa SB, Zhou L, Gandhi P, Mancini S, Metanis I, Leker RR, Pan K, Dantu V, Baumgartner K, Burton TM, Von Rennenberg R, Nolte CH, Choi R, MacDonald J, Bavarsad Shahripour R, Guo X, Ghannam M, Almajali M, Samaniego EA, Rioux B, Zine-Eddine F, Poppe A, Fonseca AC, Baptista MF, Cruz D, Romoli M, De Marco G, Longoni M, Keser Z, Griffin KJ, Kuohn L, Frontera JA, Amar JY, Giles JA, Zedde M, Pascarella R, Grisendi I, Nzwalo H, Liebeskind DS, Molaie A, Cavalier A, Kam W, Mac Grory B, Al Kasab S, Anadani M, Kicielinski KP, Eltatawy A, Chervak L, Chulluncuy Rivas R, Aziz YN, Mistry EA, Bakradze E, Tran TL, Rodrigo-Gisbert M, Requena M, Saleh Velez FG, Garcia JO, Muddasani V, de Havenon A, Sanchez S, Vishnu VY, Yaddanapudi S, Adams L, Browngoehl A, Ranasinghe T, Dunston R, Lynch Z, Penckofer M, Siegler JE, Mayer S, Willey JZ, Zubair AS, Cheng YK, Sharma R, Marto JP, Krupka D, Klein P, Nguyen TN, Asad SD, Sarwat Z, Balabhadra A, Patel S, Secchi T, Martins SC, Mantovani GP, Kim YD, Krishnaiah B, Elangovan C, Lingam S, Qureshi AY, Fridman S, Alvarado A, Khasiyev F, Linares G, Mannino M, Terruso V, Tountopoulou A, Tentolouris-Piperas V, Martinez-Marino MM, Carrasco Wall V, Indraswari F, El Jamal SE, Liu S, Zhou M, Alvi MM, Ali F, Sarvath M, Morsi RZ, Kass-Hout T, Shi F, Zhang J, Sokhi D, Said J, Mongare N, Simpkins AN, Gomez R, Sen S, Ghani M, Elnazeir M, Wangqin R, Xiao H, Kala NS, Khan F, Stretz C, Mohammadzadeh N, Goldstein ED, Furie K, Yaghi S. Intravenous Thrombolysis in Patients With Cervical Artery Dissection: A Secondary Analysis of the STOP-CAD Study. Neurology. 2024 Oct 8;103(7):e209843.

Published In

Neurology

DOI

10.1212/WNL.0000000000209843

EISSN

1526-632X

Publication Date

October 8, 2024

Volume

103

Issue

7

Start / End Page

e209843

Location

United States

Related Subject Headings

  • Vertebral Artery Dissection
  • Treatment Outcome
  • Tissue Plasminogen Activator
  • Thrombolytic Therapy
  • Retrospective Studies
  • Neurology & Neurosurgery
  • Middle Aged
  • Male
  • Ischemic Stroke
  • Intracranial Hemorrhages