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

Between March 1996 and December 1997, 15 consecutive patients with carotid artery occlusion diagnosed with duplex sonography were treated with intrave nous recombinant tissue plasminogen activator (rt-PA), following a protocol similar to that of the National Institute of Neurological Disorders and St roke (NINDS) study. On the basis of ultrasound findings, sis of the 15 pati ents had internal carotid artery dissection (ICD), and the remaining nine h ad atherothrombotic internal carotid artery (ICA) occlusion. No relevant ha emorrhagic complications were observed after rt-Prl treatment of ICA occlus ion. Excellent late functional outcome was observed in three of the 15 pati ents with ICA occlusion, moderate and poor outcome in four patients. Four p atients 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 devas tating, our data do not corroborate the hypothesis that patients with acute ischemic stroke following ICA occlusion should a priori be excluded from i ntravenous thrombolysis. The possible benefit of rt-PA treatment in stroke following acute or chronic ICA occlusion should be assessed in a larger pro spective trial, for which this case series might serve as a pilot study. Eu r J Neurol 6:51-55 (C) 1999 Lippincott Williams & Wilkins.