Journal
CEREBROVASCULAR DISEASES
Volume 27, Issue 4, Pages 368-374Publisher
KARGER
DOI: 10.1159/000202427
Keywords
Stroke, acute; Thrombolysis, Intra-arterial; Hemorrhage, intracerebral
Categories
Funding
- Bundesministerium fur Bildung und Wissenschaft, Stanford
- National Institute for Neurological Disorders and Stroke, Los Angeles [RO1 NS39325, K23 NS051372]
- NIH, Paris [5P50NS044378-03, PHRC AOM 03 008]
- Ministry of Science and Technology of Korea [M103KV010010 06K2201 01010]
- NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND STROKE [P50NS044378, R01NS039325, K23NS051372] Funding Source: NIH RePORTER
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Background: In intra-arterial (IA) thrombolysis trials, higher rates of symptomatic intracerebral haemorrhage (sICH) were found than in trials with intravenous (IV) recombinant tissue plasminogen activator (tPA); this observation could have been due to the inclusion of more severely affected patients in IA thrombolysis trials. In the present study, we investigated the rate of sICH in IA and combined IV + IA thrombolysis versus IV thrombolysis after adjusting for differences in clinical and MRI parameters. Methods: In this multicenter study, we systematically analyzed data from 645 patients with anterior-circulation strokes treated with either IV or IA thrombolysis within 6 h following symptom onset. Thrombolytic regimens included (1) IV tPA treatment (n = 536) and (2) IA treatment with either tPA or urokinase (n = 74) or (3) combined IV + IA treatment with either tPA or urokinase (n = 35). Results: 44 (6.8%) patients developed sICH. sICH patients had significantly higher scores on the National Institutes of Health Stroke Scale (NIHSS) at admission and pretreatment DWI lesions. The sICH risk was 5.2% (n = 28) in IV thrombolysis, which is significantly lower than in IA (12.5%, n = 9) or IV + IA thrombolysis (20%, n = 7). In a binary logistic regression analysis including age, NIHSS score, time to thrombolysis, initial diffusion weighted imaging lesion size, mode of thrombolytic treatment and thrombolytic agent, the mode of thrombolytic treatment remained an independent predictor for sICH. The odds ratio for IA or IV + IA versus IV treatment was 3.466 (1.19-10.01, 95% CI, p < 0.05). Conclusion: In this series, IA and IV + IA thrombolysis is associated with an increased sICH risk as compared to IV thrombolysis, and this risk is independent of differences in baseline parameters such as age, initial NIHSS score or pretreatment lesion size. Copyright (C) 2009 S. Karger AG, Basel
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