Francesca Pescini1,2, Sara Torricelli3, Martina Squitieri3, Giulia Giacomucci3, Anna Poggesi4,3,5, Emanuele Puca6, Silvia Bianchi7, Michele Ragno8, Leonardo Pantoni9. 1. Emergency Department, Stroke Unit, AOU Careggi, Florence, Italy. francesca.pescini@unifi.it. 2. NEUROFARBA Department, University of Florence, Florence, Italy. francesca.pescini@unifi.it. 3. NEUROFARBA Department, University of Florence, Florence, Italy. 4. Emergency Department, Stroke Unit, AOU Careggi, Florence, Italy. 5. IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy. 6. Division of Neurology, Madonna del Soccorso Hospital, ASUR Marche, Ascoli Piceno, San Benedetto del Tronto, Italy. 7. Neurology and Neurometabolic Unit, Department of Medical Surgical and Neurological Sciences, University of Siena, Siena, Italy. 8. Pianeta Salute, Folignano, Ascoli Piceno, Italy. 9. Stroke and Dementia Lab, Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy.
Abstract
BACKGROUND: Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a genetic small vessel disease responsible for recurrent ischemic strokes, often with a progressive course leading to dementia and disability. On MRI, lacunes, microbleeds, and severe white matter alterations are typical features of the disease. In case of acute stroke, because of the bleeding risk associated with the disease and the doubtful efficacy of fibrinolytic treatment in a disease with poor evidence of thrombosis, the efficacy of intravenous thrombolysis remains unproven. Nevertheless, stroke is a frequent occurrence in CADASIL patients, and clinicians not unlikely may face in the emergency room the situation of a CADASIL patient with an acute stroke within the time window for thrombolysis. OBJECTIVE: We report on two CADASIL patients treated with intravenous alteplase for acute ischemic stroke, and we present a review of literature aimed to report epidemiological data, efficacy and safety of intravenous thrombolysis in CADASIL patients. METHODS: We performed a systematic review of medical literature published until August 2, 2022. Case reports and series in English language reporting on CADASIL patients and acute stroke were included. RESULTS: Both patients were treated with intravenous thrombolysis without complications and had a good clinical outcome. The systematic review identified three case reports of CADASIL patients who were treated with intravenous alteplase for acute ischemic stroke; no bleedings complications were described. CONCLUSIONS: Available data on intravenous thrombolysis in CADASIL patients are scarce but suggest that this treatment can be taken into consideration for these patients.
BACKGROUND: Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a genetic small vessel disease responsible for recurrent ischemic strokes, often with a progressive course leading to dementia and disability. On MRI, lacunes, microbleeds, and severe white matter alterations are typical features of the disease. In case of acute stroke, because of the bleeding risk associated with the disease and the doubtful efficacy of fibrinolytic treatment in a disease with poor evidence of thrombosis, the efficacy of intravenous thrombolysis remains unproven. Nevertheless, stroke is a frequent occurrence in CADASIL patients, and clinicians not unlikely may face in the emergency room the situation of a CADASIL patient with an acute stroke within the time window for thrombolysis. OBJECTIVE: We report on two CADASIL patients treated with intravenous alteplase for acute ischemic stroke, and we present a review of literature aimed to report epidemiological data, efficacy and safety of intravenous thrombolysis in CADASIL patients. METHODS: We performed a systematic review of medical literature published until August 2, 2022. Case reports and series in English language reporting on CADASIL patients and acute stroke were included. RESULTS: Both patients were treated with intravenous thrombolysis without complications and had a good clinical outcome. The systematic review identified three case reports of CADASIL patients who were treated with intravenous alteplase for acute ischemic stroke; no bleedings complications were described. CONCLUSIONS: Available data on intravenous thrombolysis in CADASIL patients are scarce but suggest that this treatment can be taken into consideration for these patients.
Authors: Hairong Dong; Haixia Ding; Kelly Young; Mila Blaivas; Paul J Christensen; Michael M Wang Journal: Stroke Date: 2013-03-12 Impact factor: 7.914
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