Intravenous rt-PA is not Associated with Increased Risk of Hemorrhage in Patients with Intracranial Aneurysms
Neurocritical Care , 07/09/2012
Sheth KN et al. – Incidental intracranial aneurysms are common in patients who were present with acute ischemic stroke and not associated with symptomatic intracerebral hemorrhage (sICH) in the population. The concern that these patients are at increased risk of hemorrhage after thrombolysis may not be warranted.Methods
- The authors performed a retrospective analysis of all acute ischemic stroke patients treated with recombinant tissue–plasminogen activator (rt–PA) at the tertiary care academic medical center from June 2006 to June 2010 who also received intracranial vessel imaging.
- Baseline clinical characteristics were prospectively determined.
- Identification of hemorrhage and the presence of aneurysm were obtained from radiology report, and neuro–imaging findings were confirmed by study investigators.
- Symptomatic intracerebral hemorrhage (sICH) was defined according to National Institutes of Neurological Disorders and Stroke criteria.
- Five percent of patients (8/172) had at least one intracranial aneurysm on vessel imaging.
- A total of seven patients (4 %) had sICH.
- There was no significant difference in intracranial aneurysms between patients with or without sICH [1/7 (14 %) vs. 7/165 (4.2 %), p=0.29].
- In one patient with sICH and an intracranial aneurysm, the location of hemorrhage was distant from the aneurysm.
- The only predictors found for sICH in the cohort were atrial fibrillation (p=0.03) and infarct size (p=0.0004).