Abstract Details

Title Intravenous Thrombolysis Versus Conservative Therapy in Extracranial Artery Dissection-related Ischemic Stroke: A Double-arm Meta-analysis of Functional and Safety Outcomes

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P6 - Poster Session 6 (5:00 PM-6:00 PM)

Poster/Presentation
Number 4-006

Objective

To compare the functional efficacy and safety outcomes of intravenous thrombolysis (IVT) versus conservative therapy in patients with acute ischemic stroke secondary to extracranial carotid or vertebral artery dissection (EAD), using a double-arm meta-analysis of observational studies published between 2003 and 2025.

Background Extracranial carotid and vertebral artery dissections (EAD) are important causes of ischemic stroke in younger patients. The safety of intravenous thrombolysis (IVT) in this setting remains debated due to hemorrhagic concerns and limited comparative evidence. We conducted an updated double-arm meta-analysis to reassess IVT safety and efficacy in EAD-related ischemic stroke.

Design/Methods We performed a systematic review and meta-analysis following PRISMA guidelines. PubMed, Embase, and Cochrane databases were searched through March 2025 for studies comparing intravenous thrombolysis (IVT) versus conservative management in ischemic stroke due to extracranial carotid or vertebral artery dissection. Data were extracted independently and analyzed using Review Manager (RevMan 5.4) and Mantel–Haenszel fixed- or random-effects models. The primary outcome was 90-day favorable functional outcome (mRS 0–2). Secondary outcomes included excellent functional outcome (mRS 0–1), intracranial hemorrhage, mortality, and recurrent stroke.

Results Five observational studies (n ≈ 13,300; IVT = 1,360, non-IVT = 9,925) met inclusion.
mRS 0–2 OR 0.86 (95 % CI 0.67–1.10); mRS 0–1 OR 0.78 (0.63–0.97); ICH OR 2.15 (1.01–4.56); mortality OR 3.38 (2.85–4.03); recurrent stroke OR 2.13 (0.39–11.45). Heterogeneity was low except for ICH (I² = 60 %). IVT achieved similar 90-day functional outcomes and no excess symptomatic hemorrhage or recurrent stroke compared with conservative management.

Conclusions

Intravenous thrombolysis in extracranial carotid and vertebral artery dissection–related ischemic stroke provides comparable safety and functional outcomes to conservative therapy. These findings suggest that extracranial arterial dissection should not be considered a contraindication to IVT when standard eligibility criteria are met.

Authors/Disclosures
Sangharsha Thapa, MD PRESENTER	Dr. Thapa has nothing to disclose.
Sangam Shah (Tribhuvan University, Institute of Medicine)	Dr. Shah has nothing to disclose.
Ahmed Elmashad, MD	Dr. Elmashad has nothing to disclose.
Chaitanya Medicherla, MD	Dr. Medicherla has nothing to disclose.
Fawaz Al-Mufti, MD (Westchester Medical Center at New York Medical College)	Dr. Al-Mufti has received personal compensation in the range of $0-$499 for serving as a Consultant for Stryker. Dr. Al-Mufti has received personal compensation in the range of $0-$499 for serving as a Consultant for Cerenovus. Dr. Al-Mufti has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Revalesio .

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