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Thrombolysis associated intracerebral hemorrhage

Shuang Wang, Yan Lv, Xin Zheng, Jing Qiu, Hui-Sheng Chen
It is still controversial whether pre-existing cerebral microbleeds (CMBs) increase the risks of intracranial hemorrhage (ICH) and poor functional outcome (PFO) in acute ischemic stroke (AIS) patients treated with intravenous thrombolysis (IVT). Therefore, we performed a systematic review and meta-analysis to determine the impact of CMBs on ICH and PFO of AIS patients with IVT. We searched PubMed, EMBASE and Web of Science from inception to August 3, 2016, with language restriction in English. We included studies that reported the relationship between CMBs and ICH or PFO after thrombolysis...
November 24, 2016: Journal of Neurology
Maurizio Paciaroni, Leonardo Pantoni
The administration of thrombolytic therapy in elderly patients with dementia and acute ischemic stroke may be controversial, because the reported risk of rt-PA associated intracerebral hemorrhage in these patients is higher compared with that of patients without dementia and because these patients are already disabled. Moreover, there are known risk factors for hemorrhagic transformation in patients with dementia: amyloid angiopathy, leukoaraiosis and the presence of microbleeds. In this review, we describe the impact of dementia on functional outcome following thrombolytic therapy for acute ischemic stroke and discuss some of the issues related to the use of this therapy in this specific patient's population...
October 3, 2016: Neurological Sciences
Andreas Charidimou, Ashkan Shoamanesh
OBJECTIVE: We performed a systematic review and meta-analysis to assess whether the presence of cerebral microbleeds (CMBs) on pretreatment MRI of patients with acute ischemic stroke treated with IV thrombolysis is associated with increased risk of symptomatic intracerebral hemorrhage (ICH) and poor functional outcome. METHODS: We searched PubMed for relevant studies and calculated pooled odds ratios (OR) for symptomatic ICH and poor (i.e., modified Rankin Scale score >2) 3- to 6-month functional outcome using random effects models with DerSimonian-Laird weights among individuals with vs without CMBs...
October 11, 2016: Neurology
S Curtze, G Sibolt, S Melkas, S Mustanoja, E Haapaniemi, J Putaala, T Sairanen, M Tiainen, T Tatlisumak, D Strbian
BACKGROUND AND PURPOSE: The development of intracerebral hemorrhage following intravenous thrombolysis (IVT) can be influenced by various confounders related to the underlying vessel and tissue conditions. There are some data on association of cause of the stroke and the hemorrhage transformation. We tested the hypothesis that the cause of stroke is associated with the development of symptomatic intracerebral hemorrhage (sICH) following IVT. METHODS: A consecutive cohort of 2485 IVT-treated patients at the Helsinki University Central Hospital was classified according to the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) criteria...
December 2016: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
Andreas Charidimou, Marco Pasi, Marco Fiorelli, Sara Shams, Rüdiger von Kummer, Leonardo Pantoni, Natalia Rost
BACKGROUND AND PURPOSE: We performed a meta-analysis to assess whether leukoaraiosis on brain computed tomographic scans of acute ischemic stroke patients treated with intravenous thrombolysis is associated with an increased risk of symptomatic intracerebral hemorrhage (sICH) or poor functional outcome at 3 to 6 months after stroke, or both. METHODS: We searched PubMed and pooled relevant data in meta-analyses using random effects models. Using odds ratios (OR), we quantified the strength of association between the presence and severity of leukoaraiosis and post-thrombolysis sICH or 3- to 6-month modified Rankin Score >2...
September 2016: Stroke; a Journal of Cerebral Circulation
Renee' H Martin, Sharon D Yeatts, Michael D Hill, Claudia S Moy, Myron D Ginsberg, Yuko Y Palesch
BACKGROUND AND PURPOSE: The ALIAS (Albumin in Acute Ischemic Stroke) part 1 and 2 trials evaluated whether 25% human serum albumin improves clinical outcomes after acute ischemic stroke above and beyond standard of care using similar protocols. The part 1 trial ended prematurely because of safety concerns, and the part 2 trial terminated early because of futility of finding a statistically significant effect of albumin over saline (control) administration. We combine the subject-level data of the part 1 and 2 trials to reevaluate the efficacy and safety outcomes with the larger sample size...
September 2016: Stroke; a Journal of Cerebral Circulation
Sang Hyun Shon, Sung Hyuk Heo, Bum Joon Kim, Hye-Yeon Choi, Youngnam Kwon, Sang Hun Yi, Ji Sung Lee, Young Seo Kim, Hyun Young Kim, Seong-Ho Koh, Dae-Il Chang
BACKGROUND: Symptomatic intracerebral hemorrhage (sICH) is one of the most feared complications after administration of intravenous recombinant tissue plasminogen activator (IV rtPA). The aim of this study was to determine correlations between hemorrhage volume (HV) after IV rtPA treatment and risk factors for sICH. METHODS: We analyzed 318 patients from the stroke registries of 4 hospitals in Korea. We confirmed hemorrhage by computed tomography (CT) or magnetic resonance imaging within 36 hours...
October 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Waltraud Pfeilschifter, Dana Farahmand, Daniela Niemann, Benno Ikenberg, Carina Hohmann, Mario Abruscato, Sven Thonke, Adam Strzelczyk, Günther Hedtmann, Tobias Neumann-Haefelin, Rainer Kollmar, Oliver C Singer, Andreas Ferbert, Thorsten Steiner, Helmuth Steinmetz, Anke Reihs, Björn Misselwitz, Christian Foerch
BACKGROUND: The first specific antidote for non-vitamin K antagonist oral anticoagulants (NOAC) has recently been approved. NOAC antidotes will allow specific treatment for 2 hitherto problematic patient groups: patients with oral anticoagulant therapy (OAT)-associated intracerebral hemorrhage (ICH) and maybe also thrombolysis candidates presenting on oral anticoagulation (OAT). We aimed to estimate the frequency of these events and hence the quantitative demand of antidote doses on a stroke unit...
2016: Cerebrovascular Diseases
Luis Prats-Sánchez, Pol Camps-Renom, Javier Sotoca-Fernández, Raquel Delgado-Mederos, Alejandro Martínez-Domeño, Rebeca Marín, Miriam Almendrote, Laura Dorado, Meritxell Gomis, Javier Codas, Laura Llull, Alejandra Gómez González, Jaume Roquer, Francisco Purroy, Manuel Gómez-Choco, David Cánovas, Dolores Cocho, Moises Garces, Sonia Abilleira, Joan Martí-Fàbregas
BACKGROUND AND PURPOSE: Remote parenchymal hemorrhage (rPH) after intravenous thrombolysis with recombinant tissue-type plasminogen activator may be associated with cerebral amyloid angiopathy, although supportive data are limited. We aimed to investigate risk factors of rPH after intravenous thrombolysis with recombinant tissue-type plasminogen activator. METHODS: This is an observational study of patients with ischemic stroke who were treated with intravenous thrombolysis with recombinant tissue-type plasminogen activator and were included in a multicenter prospective registry...
August 2016: Stroke; a Journal of Cerebral Circulation
Junfeng Liu, Deren Wang, Yao Xiong, Bian Liu, Chenchen Wei, Zhenxing Ma, Bo Wu, Ruozhen Yuan, Hehan Tang, Ming Liu
Calcium is an essential element for life and has cerebroprotective property in stroke patients. Low serum calcium levels were found to be related to large hematoma volumes in intracerebral hemorrhagic patients and hemorrhagic transformation in ischemic stroke patients after thrombolysis. However, their impact on hemorrhage-prone small vessel disease represented by cerebral microbleeds (CMBs) is uncertain. We aim to investigate whether low serum calcium levels are associated with presence and location of CMBs...
June 2016: Medicine (Baltimore)
Jan-Dirk Vermeij, Willeke F Westendorp, Yvo B Roos, Matthijs C Brouwer, Diederik van de Beek, Paul J Nederkoorn
BACKGROUND: The Preventive Antibiotics in Stroke Study (PASS), a randomized open-label masked endpoint trial, showed that preventive ceftriaxone did not improve functional outcome at 3 months in patients with acute stroke (adjusted common OR 0.95; 95% CI 0.82-1.09). Post-hoc analyses showed that among patients who received intravenous thrombolysis (IVT), patients who received ceftriaxone had a significantly better outcome as compared with the control group. This study aimed to gain more insight into the characteristics of these patients...
2016: Cerebrovascular Diseases
Dipender Gill, Aravindhan Baheerathan, Adarsh Aravind, Roland Veltkamp, Arindam Kar
BACKGROUND: Intravenous thrombolysis can improve neurological outcomes after acute ischemic stroke (AIS), but hemorrhagic transformation (HT) of the infarct remains a risk. Current definitions for symptomatic intracerebral hemorrhage (ICH) all entail that there be some degree of associated neurological deterioration. However, early deleterious effects of secondary ICH might also be manifested as reduced neurological improvement. This study aims to investigate whether there are any independent associations between different radiological subtypes of HT and the degree of neurological improvement 24 hours after thrombolysis...
September 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Sang-Hwa Lee, Beom Joon Kim, Moon-Ku Han, Tai Hwan Park, Kyung Bok Lee, Byung-Chul Lee, Kyung-Ho Yu, Mi Sun Oh, Jae Kwan Cha, Dae-Hyun Kim, Hyun-Wook Nah, Jun Lee, Soo Joo Lee, Youngchai Ko, Jae Guk Kim, Jong-Moo Park, Kyusik Kang, Yong-Jin Cho, Keun-Sik Hong, Jay Chol Choi, Joon-Tae Kim, Kangho Choi, Dong-Eog Kim, Wi-Sun Ryu, Wook-Joo Kim, Dong-Ick Shin, Minju Yeo, Juneyoung Lee, Ji Sung Lee, Philip B Gorelick, Hee-Joon Bae
BACKGROUND: Current guidelines have contraindicated history of intracerebral hemorrhage for intravenous recombinant tissue plasminogen activator. AIM: This study aimed to investigate the safety and effectiveness of intravenous recombinant tissue plasminogen activator for patients who had previous intracerebral hemorrhage on history or initial brain magnetic resonance imaging. METHODS: Using a prospective multicenter stroke registry database, we identified acute ischemic stroke patients treated with intravenous recombinant tissue plasminogen activator within 4...
October 2016: International Journal of Stroke: Official Journal of the International Stroke Society
Bharath Kumar Cheripelli, Xuya Huang, Rachael MacIsaac, Keith W Muir
BACKGROUND AND PURPOSE: Both intracerebral hemorrhage (ICH) and brain edema have been attributed to reperfusion after intravenous thrombolysis. We explored the interaction of recanalization and core size for imaging outcomes (ICH and vasogenic brain edema). METHODS: In patients with anterior circulation occlusion given intravenous thrombolysis <4.5 hours and imaged with computed tomographic (CT) perfusion and CT angiography, we defined volumes of core (relative delay time >2 s and relative cerebral blood flow <40%) and penumbra (relative delay time >2 s)...
July 2016: Stroke; a Journal of Cerebral Circulation
Michael E Abboud, Roger Band, Judy Jia, William Pajerowski, Guy David, Michelle Guo, C Crawford Mechem, Steven R Messé, Brendan G Carr, Michael T Mullen
OBJECTIVE: Hospital arrival via Emergency Medical Services (EMS) and EMS prenotification are associated with faster evaluation and treatment of stroke. We sought to determine the impact of diagnostic accuracy by prehospital providers on emergency department quality measures. METHODS: A retrospective study was performed of patients presenting via EMS between September 2009 and December 2012 with a discharge diagnosis of transient ischemic attack (TIA), ischemic stroke (IS), or intracerebral hemorrhage (ICH)...
May 31, 2016: Prehospital Emergency Care
Ricardo C Nogueira, Edson Bor-Seng-Shu, Nazia P Saeed, Manoel J Teixeira, Ronney B Panerai, Thompson G Robinson
BACKGROUND: The present review investigated which findings in vascular imaging techniques can be used to predict clinical outcome and the risk of symptomatic intracerebral hemorrhage (sICH) in patients who underwent intravenous thrombolytic treatment. METHODS: Publications were searched, and the inclusion criteria were as follows: (1) published manuscripts, (2) patients with acute ischemic stroke managed with intravenous recombinant tissue plasminogen activator (rtPA), and (3) availability of imaging assessment to determine vessel patency or the regulation of cerebral blood flow prior to, during, and/or after thrombolytic treatment...
2016: Frontiers in Neurology
Felix C Ng, Skye Coote, Tanya Frost, Chris Bladin, Philip M Choi
BACKGROUND AND PURPOSE: The use of thrombolysis in acute minor ischemic stroke (MIS) remains controversial. We sought to determine the safety and efficacy of intravenous tissue-type plasminogen activator (IV-tPA) in acute MIS patients with demonstrable penumbra on computed tomographic perfusion study. METHODS: Consecutive MIS patients with National Institutes of Health Stroke Scale ≤3 were identified from a prospective single tertiary-center database over a 4...
July 2016: Stroke; a Journal of Cerebral Circulation
Thomas V Kodankandath, Jane Shaji, Nina Kohn, Rohan Arora, Elliott Salamon, Richard B Libman, Jeffrey M Katz
BACKGROUND: The "drip-and-ship" paradigm is an important treatment modality for acute ischemic stroke (AIS) patients who do not have immediate access to a comprehensive stroke center (CSC). Intravenous thrombolysis is initiated at a primary stroke center followed by expeditious transfer to a CSC. We sought to determine factors associated with poor outcomes in drip-and-ship AIS patients transferred to a CSC. METHODS: This study is a retrospective analysis of 130 consecutive drip-and-ship patients transferred by ambulance to a single CSC between July 2012 and June 2014...
August 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Georgios Tsivgoulis, Ramin Zand, Aristeidis H Katsanos, Guillaume Turc, Christian H Nolte, Simon Jung, Charlotte Cordonnier, Jochen B Fiebach, Jan F Scheitz, Pascal P Klinger-Gratz, Catherine Oppenheim, Nitin Goyal, Apostolos Safouris, Heinrich P Mattle, Anne W Alexandrov, Peter D Schellinger, Andrei V Alexandrov
IMPORTANCE: Cerebral microbleeds (CMBs) have been established as an independent predictor of cerebral bleeding. There are contradictory data regarding the potential association of CMB burden with the risk of symptomatic intracerebral hemorrhage (sICH) in patients with acute ischemic stroke (AIS) treated with intravenous thrombolysis (IVT). OBJECTIVE: To investigate the association of high CMB burden (>10 CMBs on a pre-IVT magnetic image resonance [MRI] scan) with the risk of sICH following IVT for AIS...
June 1, 2016: JAMA Neurology
Po-Jen Hsu, Chih-Hao Chen, Shin-Joe Yeh, Li-Kai Tsai, Sung-Chun Tang, Jiann-Shing Jeng
BACKGROUND: D-dimer is a fibrin degradation product and a possible marker of thromboembolic events. The aim of this study was to investigate the relationship between D-dimer levels and outcome in acute ischemic stroke (AIS) patients receiving intravenous thrombolysis. METHODS: This retrospective study included AIS patients who received intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) and provided plasma D-dimer level within 24 h after stroke onset during 2009 and 2014 at a single medical center...
2016: Cerebrovascular Diseases
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