Stroke following internal carotid artery occlusion - a contra-indication for intravenous thrombolysis?

Between March 1996 and December 1997, 15 consecutive patients with carotid artery occlusion diagnosed with duplex sonography were treated with intravenous recombinant tissue plasminogen activator (rt-PA), following a protocol similar to that of the National Institute of Neurological Disorders and Stroke (NINDS) study. On the basis of ultrasound findings, six of the 15 patients had internal carotid artery dissection (ICD), and the remaining nine had atherothrombotic internal carotid artery (ICA) occlusion. No relevant haemorrhagic complications were observed after rt-PA treatment of ICA occlusion. Excellent late functional outcome was observed in three of the 15 patients with ICA occlusion, moderate and poor outcome in four patients. Four patients died, and mortality was related to stroke severity upon admission. A good outcome seemed to be more likely in the small group of patients with ICD, than in the patients suffering atherothrombotic ICA occlusion. As the results of rt-PA treatment in this case series are by no means devastating, our data do not corroborate the hypothesis that patients with acute ischemic stroke following ICA occlusion should a priori be excluded from intravenous thrombolysis. The possible benefit of rt-PA treatment in stroke following acute or chronic ICA occlusion should be assessed in a larger prospective trial, for which this case series might serve as a pilot study. Copyright 1999 Lippincott Williams & Wilkins