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Thrombolysis in cervical artery dissection.

Safety and efficacy of intravenous (IVT) and intra-arterial thrombolysis (LIT) in patients with acute stroke due to spontaneous cervical artery dissection were not assessed in any controlled randomized trial. Data on IVT are derived from 4 studies with a total of 50 patients aged 48 +/- 10 years with internal carotid artery dissection. No new or worsened local signs on the side of dissection, such as Horner syndrome and cranial nerve palsy, and no rupture of the cervical carotid artery or subarachnoid hemorrhage (SAH) were observed. One patient dramatically deteriorated during IVT, probably due to arterial embolism arising from a thrombus dislocated from the dissection site. Mortality was 8%, while 40% of patients had a good outcome defined by a modified Rankin scale (mRS) score of 0-2 points. Up to date, a total of 15 patients with carotid or vertebral artery dissection treated with LIT were described. No intracranial hemorrhage, rupture of the dissected vessel, SAH, or recurrent arterial embolism were reported in any patient. Mortality was 13%, while good outcome (mRS score 0-2 points) was observed in 60% of patients, which is comparable to the results in the active group of the PROACT II study. Currently available data thus suggest that IVT should not be withheld in patients with acute stroke due to cervical artery dissection. LIT treatment can only be based on individual decision-making.