BACKGROUND AND PURPOSE: Combined analysis of the Interventional Management of Stroke I and II trials demonstrated a significant association between microcatheter contrast injections and both intracranial hemorrhage (ICH) and contrast extravasation following combined intravenous (IV) and intra-arterial (IA) thrombolysis. The reliability of these observations was tested in our local registry of IA cases. DESIGN/ METHODS: Treatment angiograms and post-procedure CTs of patients treated with combined IV/IA or IA only recombinant tissue plasminogen activator for ICA-T, M1 or M2 occlusions (n=77) were reviewed. The number of microcatheter injections (MCIs) within/distal to the target occlusion was assigned for every case. The association of MCIs to total ICH, total parenchymal hematoma (PH1+PH2) and PH2 after adjusting for significant covariates was tested. RESULTS: MCIs were used in 21 (27%) cases (range MCI 0-6). Any ICH occurred in 38 (49%) cases, including eight (10%) PH1s and eight (10%) PH2s. The use of MCIs was associated with increased PH (p=0.04), PH2 (p=0.07) and total ICH (p=0.03). MCIs were associated with increased contrast extravasation (CEx) (p=0.02). ICH was observed in all CEx cases (n=5, 100% vs 46% non-CEx; p=0.03), and four (80%) CEx cases developed PH2s (p<0.01). MCIs remained associated with total ICH after adjustment for significant covariates of Thromolysis in Cerebral Infarction score, glucose level and presence of atrial fibrillation (OR 3.60; 95% CI 1.12 to 11.49, p=0.03). MCI use was the only significantly associated covariate for total PHs. CONCLUSIONS: MCI use was associated with ICH and with clinically significant PHs in this cohort, providing further evidence that MCIs be reduced during IA thrombolysis.
BACKGROUND AND PURPOSE: Combined analysis of the Interventional Management of Stroke I and II trials demonstrated a significant association between microcatheter contrast injections and both intracranial hemorrhage (ICH) and contrast extravasation following combined intravenous (IV) and intra-arterial (IA) thrombolysis. The reliability of these observations was tested in our local registry of IA cases. DESIGN/ METHODS: Treatment angiograms and post-procedure CTs of patients treated with combined IV/IA or IA only recombinant tissue plasminogen activator for ICA-T, M1 or M2 occlusions (n=77) were reviewed. The number of microcatheter injections (MCIs) within/distal to the target occlusion was assigned for every case. The association of MCIs to total ICH, total parenchymal hematoma (PH1+PH2) and PH2 after adjusting for significant covariates was tested. RESULTS: MCIs were used in 21 (27%) cases (range MCI 0-6). Any ICH occurred in 38 (49%) cases, including eight (10%) PH1s and eight (10%) PH2s. The use of MCIs was associated with increased PH (p=0.04), PH2 (p=0.07) and total ICH (p=0.03). MCIs were associated with increased contrast extravasation (CEx) (p=0.02). ICH was observed in all CEx cases (n=5, 100% vs 46% non-CEx; p=0.03), and four (80%) CEx cases developed PH2s (p<0.01). MCIs remained associated with total ICH after adjustment for significant covariates of Thromolysis in Cerebral Infarction score, glucose level and presence of atrial fibrillation (OR 3.60; 95% CI 1.12 to 11.49, p=0.03). MCI use was the only significantly associated covariate for total PHs. CONCLUSIONS: MCI use was associated with ICH and with clinically significant PHs in this cohort, providing further evidence that MCIs be reduced during IA thrombolysis.
Authors: S Prothmann; B Friedrich; T Boeckh-Behrens; C Zimmer; J Kaesmacher; K Lucia; C Maegerlein Journal: Clin Neuroradiol Date: 2017-01-12 Impact factor: 3.649
Authors: T A Tomsick; P Khatri; T Jovin; B Demaerschalk; T Malisch; A Demchuk; M D Hill; E Jauch; J Spilker; J P Broderick Journal: Neurology Date: 2010-03-30 Impact factor: 9.910
Authors: N Lummel; G Schulte-Altedorneburg; C Bernau; T Pfefferkorn; M Patzig; H Janssen; C Opherk; H Brückmann; J Linn Journal: AJNR Am J Neuroradiol Date: 2013-08-01 Impact factor: 3.825
Authors: T A Tomsick; L D Foster; D S Liebeskind; M D Hill; J Carrozella; M Goyal; R von Kummer; A M Demchuk; I Dzialowski; V Puetz; T Jovin; H Morales; Y Y Palesch; J Broderick; P Khatri; S D Yeatts Journal: AJNR Am J Neuroradiol Date: 2015-07-30 Impact factor: 3.825