Fjorda Myslimi1, François Caparros1, Nelly Dequatre-Ponchelle1, Solène Moulin1, Sophie Gautier1, Patrick Girardie1, Charlotte Cordonnier1, Régis Bordet1, Didier Leys2. 1. From the Departments of Neurology (F.M., F.C., N.D.-P., S.M., C.C., D.L.), Intensive Care Medicine (P.G.), and Pharmacology (S.G., R.B.), University Lille 2, Lille, France; INSERM U 1171, Lille University Hospital (S.M., S.G., C.C., R.B., D.L.), Lille, France; and University of Medicine of Tirana, Tirana, Albania (F.M.). 2. From the Departments of Neurology (F.M., F.C., N.D.-P., S.M., C.C., D.L.), Intensive Care Medicine (P.G.), and Pharmacology (S.G., R.B.), University Lille 2, Lille, France; INSERM U 1171, Lille University Hospital (S.M., S.G., C.C., R.B., D.L.), Lille, France; and University of Medicine of Tirana, Tirana, Albania (F.M.). didier.leys@univ-lille2.fr.
Abstract
BACKGROUND AND PURPOSE: Orolingual angioedema (OLAE) is a life-threatening complication of intravenous thrombolysis. Our objective was to compare outcomes of patients with and without OLAE. METHODS: We prospectively included consecutive patients who received intravenous thrombolysis for cerebral ischemia at Lille University Hospital. We examined tongue and lips every 15 minutes during thrombolysis and ≤30 minutes after. We evaluated the 3-month outcome with the modified Rankin scale (mRS) and compared outcomes of patients with and without OLAE. RESULTS: Of 923 consecutive patients, 20 (2.2%) developed OLAE. None of them needed oro-tracheal intubation. They were more likely to be under angiotensin-converting enzyme inhibitors (adjusted odds ratio [adjOR], 3.9; 95% confidence interval [CI], 1.6-9.7; P=0.005) to have total insular infarcts (OR, 5.0; 95% CI, 1.5-16.5; P=0.004) and tended to develop more symptomatic intracerebral hemorrhages. Results concerning angiotensin-converting enzyme inhibitors were not modified after adjustment for propensity scores (OR, 4.4; 95% CI, 1.6-11.9; P=0.004) or matched analysis based on propensity scores (OR, 3.4; 95% CI, 1.3-8.1; P=0.010). Patients with OLAE did not significantly differ at 3 months for the proportion of patients with mRS score of 0 to 1 (adjOR, 0.9; 95% CI, 0.3-2.1), mRS score of 0 to 2 (adjOR, 0.8; 95% CI, 0.1-1.8), and death (adjOR, 1.1; 95% CI, 0.3-3.8). CONCLUSIONS: OLAE occurs in 1 of 50 patients who receive intravenous thrombolysis, 1 of 10 in case of total insular infarct, and 1 of 6 if they are under angiotensin-converting enzyme inhibitors. Their long-term outcome does not differ from that of other patients.
BACKGROUND AND PURPOSE:Orolingual angioedema (OLAE) is a life-threatening complication of intravenous thrombolysis. Our objective was to compare outcomes of patients with and without OLAE. METHODS: We prospectively included consecutive patients who received intravenous thrombolysis for cerebral ischemia at Lille University Hospital. We examined tongue and lips every 15 minutes during thrombolysis and ≤30 minutes after. We evaluated the 3-month outcome with the modified Rankin scale (mRS) and compared outcomes of patients with and without OLAE. RESULTS: Of 923 consecutive patients, 20 (2.2%) developed OLAE. None of them needed oro-tracheal intubation. They were more likely to be under angiotensin-converting enzyme inhibitors (adjusted odds ratio [adjOR], 3.9; 95% confidence interval [CI], 1.6-9.7; P=0.005) to have total insular infarcts (OR, 5.0; 95% CI, 1.5-16.5; P=0.004) and tended to develop more symptomatic intracerebral hemorrhages. Results concerning angiotensin-converting enzyme inhibitors were not modified after adjustment for propensity scores (OR, 4.4; 95% CI, 1.6-11.9; P=0.004) or matched analysis based on propensity scores (OR, 3.4; 95% CI, 1.3-8.1; P=0.010). Patients with OLAE did not significantly differ at 3 months for the proportion of patients with mRS score of 0 to 1 (adjOR, 0.9; 95% CI, 0.3-2.1), mRS score of 0 to 2 (adjOR, 0.8; 95% CI, 0.1-1.8), and death (adjOR, 1.1; 95% CI, 0.3-3.8). CONCLUSIONS:OLAE occurs in 1 of 50 patients who receive intravenous thrombolysis, 1 of 10 in case of total insular infarct, and 1 of 6 if they are under angiotensin-converting enzyme inhibitors. Their long-term outcome does not differ from that of other patients.
Authors: Mackenzie P Lerario; James C Grotta; Alexander E Merkler; Setareh Salehi Omran; Monica L Chen; Neal S Parikh; Shadi Yaghi; Santosh Murthy; Babak B Navi; Hooman Kamel Journal: Stroke Date: 2019-09-13 Impact factor: 7.914
Authors: Bruno Censori; T Partziguian; V Bonito; M Sgarzi; R Riva; D Alimonti; E Agazzi; M Vedovello; B Frigeni; E Venturelli; S La Gioia; V Barcella; L Daleffe; L Longhi; F Ferri; R Cosentini; M R Rottoli Journal: Neurol Sci Date: 2018-08-06 Impact factor: 3.307