Intravenous thrombolysis in acute ischemic stroke due to occlusion of internal carotid artery - a Serbian Experience with Thrombolysis in Ischemic Stroke (SETIS)

Zeljko Zivanovic; Slobodan Gvozdenovic; Dejana R Jovanovic; Aleksandra Lucic-Prokin; Jelena Sekaric; Sonja Lukic; Timea Kokai-Zekic; Marija Zarkov; Milan Cvijanovic; Ljiljana Beslac-Bumbasirevic; Petar Slankamenac; SETIS Investigation Group

doi:10.1016/j.clineuro.2014.03.008

Intravenous thrombolysis in acute ischemic stroke due to occlusion of internal carotid artery - a Serbian Experience with Thrombolysis in Ischemic Stroke (SETIS)

Clin Neurol Neurosurg. 2014 May:120:124-8. doi: 10.1016/j.clineuro.2014.03.008. Epub 2014 Mar 15.

Collaborators

Affiliations

¹ Medical Faculty, University of Novi Sad, Novi Sad, Serbia; Department of Neurology, Clinical Center of Vojvodina, Novi Sad, Serbia. Electronic address: drzzivanovic79@gmail.com.
² Department of Neurology, Clinical Center of Vojvodina, Novi Sad, Serbia.
³ Medical Faculty, University of Belgrade, Belgrade, Serbia; Department of Neurology, Clinical Center of Serbia, Belgrade, Serbia.
⁴ Medical Faculty, University of Novi Sad, Novi Sad, Serbia; Department of Neurology, Clinical Center of Vojvodina, Novi Sad, Serbia.

PMID: 24731591
DOI: 10.1016/j.clineuro.2014.03.008

Abstract

Objective: The benefit of intravenous thrombolysis in patients with internal carotid artery (ICA) occlusion is still unclear. The aim of this study was to assess the influence on outcome of intravenous thrombolysis in patients with ICA occlusion comparing to those without it.

Methods: Data were from the national register of all acute ischemic stroke patients treated with intravenous thrombolysis in Serbia. Patients with nonlacunar anterior circulation infarction were included and were divided into two groups, those with and those without ICA occlusion. We compared the differences in demographic characteristics, risk factors, baseline NIHSS score, early neurological improvement, 3-month functional outcome, complications and death between these two groups.

Results: Among 521 included patients there were 13.4% with ICA occlusion. Group with ICA occlusion had more males (82.9% vs. 60.5%; p=0.0008), and more severe stroke (baseline NIHSS score 15.3 vs. 13.6; p=0.004). Excellent functional outcome (mRS 0-1) at 3 months was recorded in 32.9% patients with ICA occlusion and in 50.6% patients without (p=0.009), while favorable functional outcome (mRS 0-2) was recorded in 50.0% of patients with ICA occlusion vs. 60.1% without (p=0.14). Death occurred in 12.9% patients with ICA occlusion and in 17.3% patients without it (p=0.40). There was no significant difference in rate of symptomatic ICH between the two groups (1.4% vs. 4.2%; p=0.5). Multivariate logistic regression analysis showed that ICA occlusion was associated with the absence of early neurological improvement (p=0.03; OR 1.78, 95% CI 1.05-3.04). However, the presence of ICA occlusion was not significantly associated with an unfavorable outcome at 3-month (p=0.44; OR 1.24, 95% CI 0.72-2.16) or with death (p=0.18; OR 0.57, 95% CI 0.25-1.29).

Conclusion: The patients with ICA occlusion treated with intravenous thrombolysis have a worse outcome than patients without it.

Keywords: Internal carotid artery; Intravenous thrombolysis; Occlusion; Outcome; SETIS.

MeSH terms

Aged
Brain Ischemia / drug therapy*
Brain Ischemia / epidemiology
Brain Ischemia / etiology
Carotid Artery Diseases / complications
Carotid Artery Diseases / drug therapy*
Carotid Artery Diseases / epidemiology
Carotid Artery, Internal / pathology*
Female
Humans
Male
Middle Aged
Registries / statistics & numerical data*
Serbia
Severity of Illness Index
Sex Factors
Stroke / drug therapy*
Stroke / epidemiology
Stroke / etiology
Thrombolytic Therapy / statistics & numerical data*
Treatment Outcome*