Michael V Mazya1, Niaz Ahmed2, Gary A Ford2, Carsten Hobohm2, Robert Mikulik2, A Paiva Nunes2, Nils Wahlgren2. 1. From the Department of Neurology, Karolinska University Hospital (M.V.M., N.A., N.W.) and Department of Clinical Neuroscience (M.V.M., N.A., N.W.), Karolinska Institutet, Stockholm, Sweden; Stroke Research Group, Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, Tyne and Wear, United Kingdom (G.A.F.); Department of Neurology, University of Leipzig, Leipzig, Germany (C.H.); International Clinical Research Center, Neurology Department, St Anne's Hospital, Brno, Czech Republic (R.M.); and Stroke Unit, Centro Hospitalar Lisboa Central, Lisbon, Portugal (A.P.N.). michael.mazya@karolinska.se. 2. From the Department of Neurology, Karolinska University Hospital (M.V.M., N.A., N.W.) and Department of Clinical Neuroscience (M.V.M., N.A., N.W.), Karolinska Institutet, Stockholm, Sweden; Stroke Research Group, Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, Tyne and Wear, United Kingdom (G.A.F.); Department of Neurology, University of Leipzig, Leipzig, Germany (C.H.); International Clinical Research Center, Neurology Department, St Anne's Hospital, Brno, Czech Republic (R.M.); and Stroke Unit, Centro Hospitalar Lisboa Central, Lisbon, Portugal (A.P.N.).
Abstract
BACKGROUND AND PURPOSE: Intracerebral hemorrhage after treatment with intravenous recombinant tissue-type plasminogen activator for ischemic stroke can occur in local relation to the infarct, as well as in brain areas remote from infarcted tissue. We aimed to describe risk factors, 3-month mortality, and functional outcome in patients with the poorly understood complication of remote intracerebral hemorrhage, as well as local intracerebral hemorrhage. METHODS: In this study, 43 494 patients treated with intravenous recombinant tissue-type plasminogen activator, with complete imaging data, were enrolled in the Safe Implementation of Treatments in Stroke-International Stroke Thrombolysis Register (SITS-ISTR) during 2002 to 2011. Baseline data were compared among 970 patients (2.2%) with remote parenchymal hemorrhage (PHr), 2325 (5.3%) with PH, 438 (1.0%) with both PH and PHr, and 39 761 (91.4%) without PH or PHr. Independent risk factors for all hemorrhage types were obtained by multivariate logistic regression. RESULTS: Previous stroke (P=0.023) and higher age (P<0.001) were independently associated with PHr, but not with PH. Atrial fibrillation, computed tomographic hyperdense cerebral artery sign, and elevated blood glucose were associated with PH, but not with PHr. Female sex had a stronger association with PHr than with PH. Functional independence at 3 months was more common in PHr than in PH (34% versus 24%; P<0.001), whereas 3-month mortality was lower (34% versus 39%; P<0.001). CONCLUSIONS: Differences between risk factor profiles indicate an influence of previous vascular pathology in PHr and acute large-vessel occlusion in PH. Additional research is needed on the effect of pre-existing cerebrovascular disease on complications of recanalization therapy in acute ischemic stroke.
BACKGROUND AND PURPOSE:Intracerebral hemorrhage after treatment with intravenous recombinant tissue-type plasminogen activator for ischemic stroke can occur in local relation to the infarct, as well as in brain areas remote from infarcted tissue. We aimed to describe risk factors, 3-month mortality, and functional outcome in patients with the poorly understood complication of remote intracerebral hemorrhage, as well as local intracerebral hemorrhage. METHODS: In this study, 43 494 patients treated with intravenous recombinant tissue-type plasminogen activator, with complete imaging data, were enrolled in the Safe Implementation of Treatments in Stroke-International Stroke Thrombolysis Register (SITS-ISTR) during 2002 to 2011. Baseline data were compared among 970 patients (2.2%) with remote parenchymal hemorrhage (PHr), 2325 (5.3%) with PH, 438 (1.0%) with both PH and PHr, and 39 761 (91.4%) without PH or PHr. Independent risk factors for all hemorrhage types were obtained by multivariate logistic regression. RESULTS: Previous stroke (P=0.023) and higher age (P<0.001) were independently associated with PHr, but not with PH. Atrial fibrillation, computed tomographic hyperdense cerebral artery sign, and elevated blood glucose were associated with PH, but not with PHr. Female sex had a stronger association with PHr than with PH. Functional independence at 3 months was more common in PHr than in PH (34% versus 24%; P<0.001), whereas 3-month mortality was lower (34% versus 39%; P<0.001). CONCLUSIONS: Differences between risk factor profiles indicate an influence of previous vascular pathology in PHr and acute large-vessel occlusion in PH. Additional research is needed on the effect of pre-existing cerebrovascular disease on complications of recanalization therapy in acute ischemic stroke.
Authors: Michael V Mazya; Charith Cooray; Kennedy R Lees; Danilo Toni; Gary A Ford; Michal Bar; Senta Frol; Tiago Moreira; Lakshmanan Sekaran; Viktor Švigelj; Nils Wahlgren; Niaz Ahmed Journal: Eur Stroke J Date: 2017-11-29
Authors: Luis Prats-Sanchez; Alejandro Martínez-Domeño; Pol Camps-Renom; Raquel Delgado-Mederos; Daniel Guisado-Alonso; Rebeca Marín; Laura Dorado; Salvatore Rudilosso; Alejandra Gómez-González; Francisco Purroy; Manuel Gómez-Choco; David Cánovas; Dolores Cocho; Moises Garces; Sonia Abilleira; Joan Martí-Fàbregas Journal: PLoS One Date: 2017-06-22 Impact factor: 3.240