João Pinho1, José Nuno Alves2, Liliana Oliveira3, Sara Pereira4, Joana Barros5, Célia Machado6, José Manuel Amorim7, Ana Filipa Santos8, Manuel Ribeiro9, Carla Ferreira10. 1. Neurology Department, Hospital de Braga. Sete Fontes, São Victor, 4710-243 Braga, Portugal. Electronic address: Joao.Pinho@hospitaldebraga.pt. 2. Neurology Department, Hospital de Braga. Sete Fontes, São Victor, 4710-243 Braga, Portugal. Electronic address: jose.nuno.aalves@gmail.com. 3. Internal Medicine Department, Unidade de Famalicão, Centro Hospitalar do Médio Ave. Rua Cupertino de Miranda, 4761-917 Vila Nova de Famalicão, Portugal. Electronic address: liliana.oliveira.medicina@gmail.com. 4. Internal Medicine Department, Unidade de Famalicão, Centro Hospitalar do Médio Ave. Rua Cupertino de Miranda, 4761-917 Vila Nova de Famalicão, Portugal. Electronic address: saracp86@gmail.com. 5. Internal Medicine Department, Unidade de Famalicão, Centro Hospitalar do Médio Ave. Rua Cupertino de Miranda, 4761-917 Vila Nova de Famalicão, Portugal. Electronic address: joanabarros17@gmail.com. 6. Neurology Department, Hospital de Braga. Sete Fontes, São Victor, 4710-243 Braga, Portugal. Electronic address: ccarinamachado@gmail.com. 7. Neuroradiology Department, Hospital de Braga. Sete Fontes, São Victor, 4710-243 Braga, Portugal. Electronic address: josemvamorim@gmail.com. 8. Neurology Department, Hospital de Braga. Sete Fontes, São Victor, 4710-243 Braga, Portugal. Electronic address: filipasantos@hotmail.com. 9. Neuroradiology Department, Centro Hospitalar de Vila Nova de Gaia. R. Dr. Francisco Sá Carneiro, 4400-129 Vila Nova de Gaia, Portugal. Electronic address: mqribeiro@gmail.com. 10. Neurology Department, Hospital de Braga. Sete Fontes, São Victor, 4710-243 Braga, Portugal. Electronic address: carla.m.c.ferreira@gmail.com.
Abstract
OBJECTIVE: Orolingual angioedema (OA) is a well known early complication of treatment with alteplase in ischemic stroke patients. Our aim was to study risk factors for OA in these patients, namely insular cortex ischemia. METHODS: Retrospective case-cohort study using the prospective registry of all consecutive ischemic stroke patients submitted to intravenous thrombolysis with alteplase. Clinical data was retrieved from the registry and medical records. Two independent observers evaluated early signs of insular cortex ischemia on pre-thrombolysis computed tomography (CT) and of insular cortex infarct on early follow-up imaging. Univariate and multivariate analysis were performed to identify predictors of OA. RESULTS: Of the 659 patients with acute ischemic stroke treated with alteplase, 32 developed OA (4.9%, 95%CI=3.3-6.6). Frequency of early signs of insular cortex ischemia on pre-thrombolysis CT and of insular cortex infarct on follow-up imaging was similar in patients with and without OA (p=0.241 and p=0.145, respectively). The only independent predictors of OA occurrence were female sex (OR=5.47, 95%CI=1.98-15.10) and angiotensin-converting enzyme inhibitor (ACE-I) use (OR=3.87, 95%CI=1.71-8.75). CONCLUSIONS: Female sex and ACE-I use are independent risk factors for OA occurrence in ischemic stroke patients treated with alteplase. Early signs of insular cortex ischemia on pre-thrombolysis CT were not significantly associated with OA.
OBJECTIVE:Orolingual angioedema (OA) is a well known early complication of treatment with alteplase in ischemic strokepatients. Our aim was to study risk factors for OA in these patients, namely insular cortex ischemia. METHODS: Retrospective case-cohort study using the prospective registry of all consecutive ischemic strokepatients submitted to intravenous thrombolysis with alteplase. Clinical data was retrieved from the registry and medical records. Two independent observers evaluated early signs of insular cortex ischemia on pre-thrombolysis computed tomography (CT) and of insular cortex infarct on early follow-up imaging. Univariate and multivariate analysis were performed to identify predictors of OA. RESULTS: Of the 659 patients with acute ischemic stroke treated with alteplase, 32 developed OA (4.9%, 95%CI=3.3-6.6). Frequency of early signs of insular cortex ischemia on pre-thrombolysis CT and of insular cortex infarct on follow-up imaging was similar in patients with and without OA (p=0.241 and p=0.145, respectively). The only independent predictors of OA occurrence were female sex (OR=5.47, 95%CI=1.98-15.10) and angiotensin-converting enzyme inhibitor (ACE-I) use (OR=3.87, 95%CI=1.71-8.75). CONCLUSIONS: Female sex and ACE-I use are independent risk factors for OA occurrence in ischemic strokepatients treated with alteplase. Early signs of insular cortex ischemia on pre-thrombolysis CT were not significantly associated with OA.
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