Systemic Thrombolysis in Patients With Acute Ischemic Stroke and Internal Carotid ARtery Occlusion The ICARO Study

• Published in: Stroke (1970) Vol. 43; no. 1; pp. 125 - 130
• Main Authors: PACIARONI, Maurizio, BALUCANI, Clotilde, PEZZINI, Alessandro, ALEXANDROV, Andrei V, SILVESTRINI, Mauro, FOFI, Luisa, BARLINN, Kristian, INZITARI, Domenico, FERRARESE, Carlo, TASSI, Rossana, TSIVGOULIS, Georgios, CONSOLI, Domenico, AGNELLI, Giancarlo, BALDI, Antonio, BOVI, Paolo, LUDA, Emilio, GALLETTI, Giampiero, INVERNIZZI, Paolo, LUISA DELODOVICI, Maria, COREA, Francesco, DEL SETTE, Massimo, MONACO, Serena, MARCHESELLI, Simona, CASO, Valeria, ALBERTI, Andrea, VENTI, Michele, ACCIARRESI, Monica, D'AMORE, Cataldo, MACELLARI, Federica, LANARI, Alessia, PREVIDI, Paolo, GONZALES, Nicole R, PANDURENGAN, Renganayaki K, VAHIDY, Farhaan S, SILVESTRELLI, Giorgio, SLINE, Melvin, BAL, Simerpreet S, CHITI, Alberto, GIALDINI, Gino, DUMONT, Frederic, CORDONNIER, Charlotte, DEBETTE, Stéphanie, PADOVANI, Alessandro, CERQUA, Raffaella, BODECHTEL, Ulf, GROTTA, James C, KEPPLINGER, Jessica, NESI, Mascia, NENCINI, Patrizia, BERETTA, Simone, TRENTINI, Claudia, MARTINI, Giuseppe, PIPERIDOU, Charitomeni, HELIOPOULOS, Ioannis, D'ANNA, Sebastiano, CAPPELLARI, Manuel, DEMCHUK, Andrew M, SOHN, Sung-Ii, ORLANDI, Giovanni, LEYS, Didier
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 2012
• Subjects: Aged; Aged, 80 and over; Biological and medical sciences; Brain Ischemia - drug therapy; Brain Ischemia - etiology; Carotid Artery, Internal; Carotid Stenosis - complications; Carotid Stenosis - drug therapy; Case-Control Studies; Female; Fibrinolytic Agents - adverse effects; Fibrinolytic Agents - therapeutic use; Humans; Male; Medical sciences; Middle Aged; Neurology; Neurosurgery; Skull, brain, vascular surgery; Stroke - drug therapy; Stroke - etiology; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Thrombolytic Therapy - adverse effects; Thrombolytic Therapy - methods; Time Factors; Tissue Plasminogen Activator - adverse effects; Tissue Plasminogen Activator - therapeutic use; Treatment Outcome; Vascular diseases and vascular malformations of the nervous system; Human; Cerebral infarction; Stroke; Internal carotid; Nervous system diseases; Prognosis; Cardiovascular disease; Cerebral disorder; Arterial disease; Vascular disease; carotid occlusion; acute stroke; Central nervous system disease; Brain ischemia; thrombolysis; Artery occlusion; Cerebrovascular disease; outcome
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/STROKEAHA.111.630624

The beneficial effect of intravenous thrombolytic therapy in patients with acute ischemic stroke attributable to internal carotid artery (ICA) occlusion remains unclear. The aim of this study was to evaluate the efficacy and safety of intravenous recombinant tissue-type plasminogen activator in these patients. ICARO was a case-control multicenter study on prospectively collected data. Patients with acute ischemic stroke and ICA occlusion treated with intravenous recombinant tissue-type plasminogen activator within 4.5 hours from symptom onset (cases) were compared to matched patients with acute stroke and ICA occlusion not treated with recombinant tissue-type plasminogen activator (controls). Cases and controls were matched for age, gender, and stroke severity. The efficacy outcome was disability at 90 days assessed by the modified Rankin Scale, dichotomized as favorable (score of 0-2) or unfavorable (score of 3-6). Safety outcomes were death and any intracranial bleeding. Included in the analysis were 253 cases and 253 controls. Seventy-three cases (28.9%) had a favorable outcome as compared with 52 controls (20.6%; adjusted odds ratio (OR), 1.80; 95% confidence interval [CI], 1.03-3.15; P=0.037). A total of 104 patients died, 65 cases (25.7%) and 39 controls (15.4%; adjusted OR, 2.28; 95% CI, 1.36-3.22; P=0.001). There were more fatal bleedings (2.8% versus 0.4%; OR, 7.17; 95% CI, 0.87-58.71; P=0.068) in the cases than in the controls. In patients with stroke attributable to ICA occlusion, thrombolytic therapy results in a significant reduction in the proportion of patients dependent in activities of daily living. Increases in death and any intracranial bleeding were the trade-offs for this clinical benefit.