Luis Prats-Sánchez1, Pol Camps-Renom2, Javier Sotoca-Fernández2, Raquel Delgado-Mederos2, Alejandro Martínez-Domeño2, Rebeca Marín2, Miriam Almendrote2, Laura Dorado2, Meritxell Gomis2, Javier Codas2, Laura Llull2, Alejandra Gómez González2, Jaume Roquer2, Francisco Purroy2, Manuel Gómez-Choco2, David Cánovas2, Dolores Cocho2, Moises Garces2, Sonia Abilleira2, Joan Martí-Fàbregas2. 1. From the Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute, IIB-Sant Pau, Barcelona, Spain (L.P.-S., P.C.-R., J.S.-F., R.D.-M., A.M.-D., R.M., J.M.-F.); Hospital Universitari Germans Trias i Pujol, Badalona, Spain (M.A., L.D., M.G.); Hospital Clínic de Barcelona, Barcelona, Spain (J.C., L.L.); Hospital del Mar, Barcelona, Spain (A.G.G., J.R.); Hospital Universitari Arnau de Vilanova, Lleida, Spain (F.P.); Hospital Moisès Broggi, Sant Joan Despí, Spain (M.G.-C.); Hospital Universitari de Sabadell-Corporació Sanitària Parc Taulí, Sabadell, Spain (D.C.); Hospital General Universitari de Granollers, Granollers, Spain (D.C.); Hospital Verge de la Cinta, Tortosa, Spain (M.G.); and Stroke Programme/Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S.A.). lpratss@santpau.cat. 2. From the Department of Neurology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute, IIB-Sant Pau, Barcelona, Spain (L.P.-S., P.C.-R., J.S.-F., R.D.-M., A.M.-D., R.M., J.M.-F.); Hospital Universitari Germans Trias i Pujol, Badalona, Spain (M.A., L.D., M.G.); Hospital Clínic de Barcelona, Barcelona, Spain (J.C., L.L.); Hospital del Mar, Barcelona, Spain (A.G.G., J.R.); Hospital Universitari Arnau de Vilanova, Lleida, Spain (F.P.); Hospital Moisès Broggi, Sant Joan Despí, Spain (M.G.-C.); Hospital Universitari de Sabadell-Corporació Sanitària Parc Taulí, Sabadell, Spain (D.C.); Hospital General Universitari de Granollers, Granollers, Spain (D.C.); Hospital Verge de la Cinta, Tortosa, Spain (M.G.); and Stroke Programme/Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S.A.).
Abstract
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. rPH was defined as any extraischemic hemorrhage detected in the follow-up computed tomography. We collected demographic, clinical, laboratory, radiological, and outcome variables. In the subset of patients who underwent a magnetic resonance imaging examination, we evaluated the distribution and burden of cerebral microbleeds, cortical superficial siderosis, leukoaraiosis, and recent silent ischemia in regions anatomically unrelated to the ischemic lesion that caused the initial symptoms. We compared patients with rPH with those without rPH or parenchymal hemorrhage. Independent risk factors for rPH were obtained by multivariable logistic regression analyses. RESULTS: We evaluated 992 patients (mean age, 74.0±12.6 years; 52.9% were men), and 408 (41%) of them underwent a magnetic resonance imaging. Twenty-six patients (2.6%) had a rPH, 8 (0.8%) had both rPH and PH, 58 (5.8%) had PH, and 900 (90.7%) had no bleeding complication. Lobar cerebral microbleeds (odds ratio, 8.0; 95% confidence interval, 2.3-27.2) and recent silent ischemia (odds ratio, 4.8; 95% confidence interval, 1.6-14.1) increased the risk of rPH. CONCLUSIONS: The occurrence of rPH after intravenous thrombolysis with recombinant tissue-type plasminogen activator in patients with ischemic stroke is associated with lobar cerebral microbleeds and multiple ischemic lesions in different regions.
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. rPH was defined as any extraischemic hemorrhage detected in the follow-up computed tomography. We collected demographic, clinical, laboratory, radiological, and outcome variables. In the subset of patients who underwent a magnetic resonance imaging examination, we evaluated the distribution and burden of cerebral microbleeds, cortical superficial siderosis, leukoaraiosis, and recent silent ischemia in regions anatomically unrelated to the ischemic lesion that caused the initial symptoms. We compared patients with rPH with those without rPH or parenchymal hemorrhage. Independent risk factors for rPH were obtained by multivariable logistic regression analyses. RESULTS: We evaluated 992 patients (mean age, 74.0±12.6 years; 52.9% were men), and 408 (41%) of them underwent a magnetic resonance imaging. Twenty-six patients (2.6%) had a rPH, 8 (0.8%) had both rPH and PH, 58 (5.8%) had PH, and 900 (90.7%) had no bleeding complication. Lobar cerebral microbleeds (odds ratio, 8.0; 95% confidence interval, 2.3-27.2) and recent silent ischemia (odds ratio, 4.8; 95% confidence interval, 1.6-14.1) increased the risk of rPH. CONCLUSIONS: The occurrence of rPH after intravenous thrombolysis with recombinant tissue-type plasminogen activator in patients with ischemic stroke is associated with lobar cerebral microbleeds and multiple ischemic lesions in different regions.
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