Aktuelle Neurologie 2005; 32 - P426
DOI: 10.1055/s-2005-919459

Conservative medical treatment and intravenous thrombolysis in acute stroke from carotid-T occlusion

M Wunderlich 1, E Stolz 1, G Seidel 1, T Postert 1, G Gahn 1, U Sliwka 1, M Görtler 1
  • 1For the Duplex Sonography in Acute Stroke (DIAS) Study Group

Background: We aimed to analyse the course of early recanalization and corresponding functional outcome in patients with an acute occlusion of the carotid-T who were treated conservatively or underwent intravenous thrombolysis.

Methods: 42 patients with an acute occlusion of the carotid-T within 6 hours were recruited from consecutive admissions to a neurological department participating in the Duplex Sonography in Acute Stroke (DIAS) study. All patients underwent a standardized admission and follow-up procedure. Colour-coded duplex sonography was performed on admission, 30 minutes after thrombolysis, and at 6 and 24 hours after onset of symptoms. Recanalization of the carotid-T was classified as complete, partial and absent. Functional outcome was rated with the modified Rankin Scale (mRS) at 3 months as favourable (mRS 0 to 2) or poor (mRS 3 to 6).

Results: Within 6 hours, complete or partial recanalization occurred in 1 of 27 patients treated conservatively and in 6 of 15 thrombolysed patients. Intravenous thrombolysis predicted early recanalization also after adjustment for age, sex, cardioembolic stroke aetiology and time to treatment (adjusted odds ratio [OR], 39.7; 95% confidence interval [CI], 2.0 to 801.7; P=0.016). An early recanalization was the only selected predictor of a favourable outcome (OR, 13.6; 95% CI, 1.0 to 179.0; P=0.047) at regression analysis and was achieved in 3 thrombolysed patients but in none with conservative medical treatment.

Discussion: In patients treated conservatively, functional outcome is poor and early recanalization rarely occurs. The latter can be achieved by intravenous thrombolysis with a rate comparable to that found at an intra-arterial approach without major intracranial bleeding complications. Early recanalization is associated with a better functional outcome.