Intravenous thrombolysis in patients with stroke attributable to small artery occlusion

Publication

Intravenous thrombolysis in patients with stroke attributable to small artery occlusion

Journal Paper/Review - Feb 3, 2010

Fluri F, Mattle H P, Tettenborn Barbara, Nedeltchev K, Hungerbühler H J, Sztajzel R, Baumgartner R W, Michel P, Lyrer P A, Reichhart M, Arnold M, Lüthy R, Hatz F, Rutgers M P, Georgiadis D, Sekoranja L, Schwegler G, Sarikaya H, Weder B, Müller F, Engelter S T

Citation

Fluri F, Mattle H, Tettenborn B, Nedeltchev K, Hungerbühler H, Sztajzel R, Baumgartner R, Michel P, Lyrer P, Reichhart M, Arnold M, Lüthy R, Hatz F, Rutgers M, Georgiadis D, Sekoranja L, Schwegler G, Sarikaya H, Weder B, Müller F, Engelter S. Intravenous thrombolysis in patients with stroke attributable to small artery occlusion. Eur J Neurol 2010; 17:1054-60.

Type

Journal Paper/Review (English)

Journal

Eur J Neurol 2010; 17

Publication Date

Feb 3, 2010

Issn Electronic

1468-1331

Pages

1054-60

Brief description/objective

BACKGROUND
Intravenous thrombolysis (IVT) for stroke seems to be beneficial independent of the underlying etiology. Recent observations raised concern that IVT might cause harm in patients with strokes attributable to small artery occlusion (SAO).

OBJECTIVE
The safety of IVT in SAO-patients is addressed in this study.

METHODS
We used the Swiss IVT databank to compare outcome and complications of IVT-treated SAO-patients with IVT-treated patients with other etiologies (non-SAO-patients). Main outcome and complication measures were independence (modified Rankin scale
RESULTS
Sixty-five (6.2%) of 1048 IVT-treated patients had SAO. Amongst SAO-patients, 1.5% (1/65) patients died, compared to 11.2% (110/983) in the non-SAO-group (P = 0.014). SAO-patients reached independence more often than non-SAO-patients (75.4% versus 58.9%; OR 2.14 (95% CI 1.20-3.81; P = 0.001). This association became insignificant after adjustment for age, gender, and stroke severity (OR 1.41 95% CI 0.713-2.788; P = 0.32). Glucose level and (to some degree) stroke severity but not age predicted 3-month-independence in IVT-treated SAO-patients. ICHs (all/symptomatic) were similar in SAO- (12.3%/4.6%) and non-SAO-patients (13.4%/5.3%; P > 0.8). Fatal ICH occurred in 3.3% of the non-SAO-patients but none amongst SAO-patients. Ischaemic stroke within 3 months after IVT reoccurred in 1.5% of SAO-patients and in 2.3% of non-SAO-patients (P = 0.68).

CONCLUSION
IVT-treated SAO-patients died less often and reached independence more often than IVT-treated non-SAO-patients. However, the variable 'SAO' was a dependent rather than an independent outcome predictor. The absence of an excess in ICH indicates that IVT seems not to be harmful in SAO-patients.