Intravenous Thrombolysis in Branch Atheromatous Disease: A Systematic Review and Meta-Analysis
Ahmed Alkhiri1, Ahmed Almaghrabi2, Aser Alamri1, Fahad Alturki1, Hassan Salamatullah1, Basil Alghamdi2, Fahad Al-Ajlan3, Adel Alhazzani4
1College of Medicine, King Saud bin Abdulaziz University for Health Sciences, 2College of Medicine, King Saud University for Health Sciences, 3King Faisal Specialist Hospital and Research Centre, 4King Saud University
Objective:
To evaluate the safety and efficacy of intravenous thrombolysis (IVT) in stroke caused by branch atheromatous disease (BAD), focusing on its impact on early neurological deterioration (END), functional outcomes, and the incidence of symptomatic intracerebral hemorrhage (sICH).
Background:
Branch atheromatous disease (BAD) is a unique cause of stroke resulting from atherosclerotic occlusion at the opening of major penetrating arteries. Stroke associated with BAD can lead to early neurological deterioration (END) and poor outcome, and the role of intravenous thrombolysis (IVT) is uncertain.
Design/Methods:
A systematic search of Medline/PubMed and Embase databases was performed to identify relevant studies assessing the outcomes of IVT in patients with stroke caused by BAD. Risk ratios (RR) with 95% confidence intervals (CIs) were calculated using a random-effects model, and proportions were pooled using the generalized linear mixed model.
Results:
We included five clinical studies involving 906 stroke patients (32.2% female). Among them, 700 patients (77.8%) received IVT. Following IVT, 30% of patients experienced END, while 65% achieved an excellent functional outcome (modified Rankin scale of 0-1). The incidence of symptomatic intracerebral hemorrhage after IVT was 2%. Compared to the control group, IVT resulted in significantly higher rates of excellent functional outcome (RR, 1.31 [95% CI, 1.03-1.67]; p=0.03), but the difference in END rates was not statistically significant (RR, 0.64 [95% CI, 0.39-1.04]; p=0.07).
Conclusions:
Treatment with IVT for BAD may be safe and lead to positive long-term outcomes. However, there is still a high rate of early neurological worsening. Further studies are needed to determine the best treatment options.
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.