• Marcel Arnold, Krassen Nedeltchev, Matthias Sturzenegger, Gerhard Schroth, Thomas J Loher, Frank Stepper, Luca Remonda, Claudio Bassetti, and Heinrich P Mattle.
• Department of Neurology, University of Berne, Inselspital, CH-3010 Berne, Switzerland. heinrich.mattle@insel.ch
• Arch Neurol Chicago. 2002 Apr 1;59(4):549-53.

BackgroundResults of recently published studies suggest that intravenous thrombolysis (IVT) and local intra-arterial thrombolysis (LIT) are feasible procedures in acute stroke after cervical artery dissection (CAD).ObjectivesTo describe 9 patients with acute stroke caused by CAD who were treated by LIT (n = 7) or IVT (n = 2) and to review the literature.MethodsRetrospective analysis of clinical and neuroradiological findings; literature review from 1980 to present.Main Outcome MeasureModified Rankin Scale (mRS) score.ResultsOf 7 patients treated with LIT, 3 had good outcomes (mRS score of 0-2) and 4 had bad outcomes (mRS score of 3-6) at 3 months. The 2 patients who had received IVT recovered to mRS scores of 0 and 3. Twenty-one patients were identified in the literature. Overall (N = 30), in the IVT group (n = 19), the outcome was good in 8 patients (42%) and bad in 11 (58%); in the LIT group (n = 11), 6 patients (55%) had a good outcome and 5 (45%) had a bad outcome. Overall, 47% (14/30) of the patients (IVT and LIT groups) had a good outcome. Total mortality was 13% (4/30). There were no secondary complications due to extension of wall hematoma or angiography. One symptomatic hemorrhage occurred.ConclusionsThrombolysis is feasible in acute stroke caused by CAD. Local complications from extension of wall hematoma did not occur. Further prospective studies are needed to determine the safety and efficacy of thrombolysis in the special circumstance of acute stroke caused by CAD.

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