Risk of Symptomatic Intracerebral Hemorrhage in Patients Treated with Intra-Arterial Thrombolysis

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 patient...

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Published inCerebrovascular diseases (Basel, Switzerland) Vol. 27; no. 4; pp. 368 - 374
Main Authors Singer, O.C., Berkefeld, J., Lorenz, M.W., Fiehler, J., Albers, G.W., Lansberg, M.G., Kastrup, A., Rovira, A., Liebeskind, D.S., Gass, A., Rosso, C., Derex, L., Kim, J.S., Neumann-Haefelin, T.
Format Journal Article
LanguageEnglish
Published Basel, Switzerland S. Karger AG 01.01.2009
Karger
Subjects
Aged
Cerebral Hemorrhage - epidemiology
Computer Science
Female
Fibrinolytic Agents - administration & dosage
Fibrinolytic Agents - therapeutic use
Humans
Injections, Intra-Arterial
Injections, Intravenous
Logistic Models
Male
Medical Imaging
Middle Aged
Multivariate Analysis
Original Paper
Retrospective Studies
Risk Factors
Stroke - drug therapy
Thrombolytic Therapy - adverse effects
Thrombolytic Therapy - methods
Tissue Plasminogen Activator - administration & dosage
Tissue Plasminogen Activator - therapeutic use
Urokinase-Type Plasminogen Activator - administration & dosage
Urokinase-Type Plasminogen Activator - therapeutic use
Hemorrhage, intracerebral
Stroke, acute
Thrombolysis, Intra-arterial
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Abstract 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.
AbstractList 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.
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 © 2009 S. Karger AG, Basel [PUBLICATION ABSTRACT]
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. 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). 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). 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.
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 [copy 2009 S. Karger AG, Basel
Author Lansberg, M.G.
Liebeskind, D.S.
Neumann-Haefelin, T.
Derex, L.
Kim, J.S.
Singer, O.C.
Berkefeld, J.
Gass, A.
Kastrup, A.
Rosso, C.
Fiehler, J.
Lorenz, M.W.
Albers, G.W.
Rovira, A.
AuthorAffiliation g Department of Radiology, Hospital Universitari Vall d’Hebron, Barcelona, Spain
l Department of Neurology, University of Ulsan, Asan Medical Center, Seoul, Korea
a Klinik für Neurologie, Universitätsklinik, Goethe-Universität, Frankfurt, Germany
b Institut für Neuroradiologie, Universitätsklinik, Goethe-Universität, Frankfurt, Germany
d Department of Neurology, Stanford University Medical Center, Stanford, Calif., USA
k Cerebrovascular Disease Center, Creatis UMR CNRS 5515, Inserm U 630, University of Lyon, Lyon, France
c Neuroradiologie, Universitätsklinik Eppendorf, Hamburg, Germany
e Neurologische Klinik, Universitätsklinikum, Jena, Germany
j Urgences Cérébro-Vasculaires, Salpêtrière, AP-HP, Paris, France
i Neurologische Klinik, Universitätsklinikum, Mannheim, Germany
f Neurologische Klinik, Universitätsklinikum, Göttingen, Germany
h UCLA Stroke Center, University of California, Los Angeles, Calif., USA
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BackLink https://www.ncbi.nlm.nih.gov/pubmed/19218803$$D View this record in MEDLINE/PubMed
https://inria.hal.science/hal-00796951$$DView record in HAL
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Saver, Jeffrey L
Starkman, Sidney
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Salamon, Noriko
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Moseley, Michael
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Crozier, Sophie
Kastrup, Andreas
Lecei, Olivera
Hoelig, Silke
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Zeumer, Hermann
Donnan, Geoffrey A
Sitzer, Matthias
Lansberg, Maarten G
Berkefeld, Joachim
Alvarez-Sabin, Jose
Ovbiagele, Bruce
Fiehler, Jens
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Delgado, Raquel
Molina, Carlos
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Davis, Stephen M
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Singer, Oliver C
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Kucinski, Thomas
Roether, Joachim
Steinmetz, Helmuth
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Issue 4
Keywords Hemorrhage, intracerebral
Stroke, acute
Thrombolysis, Intra-arterial
Language English
License Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Copyright 2009 S. Karger AG, Basel.
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Snippet Background: In intra-arterial (IA) thrombolysis trials, higher rates of symptomatic intracerebral haemorrhage (sICH) were found than in trials with intravenous...
In intra-arterial (IA) thrombolysis trials, higher rates of symptomatic intracerebral haemorrhage (sICH) were found than in trials with intravenous (IV)...
BACKGROUND: In intra-arterial (IA) thrombolysis trials, higher rates of symptomatic intracerebral haemorrhage (sICH) were found than in trials with intravenous...
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SubjectTerms Aged
Cerebral Hemorrhage - epidemiology
Computer Science
Female
Fibrinolytic Agents - administration & dosage
Fibrinolytic Agents - therapeutic use
Humans
Injections, Intra-Arterial
Injections, Intravenous
Logistic Models
Male
Medical Imaging
Middle Aged
Multivariate Analysis
Original Paper
Retrospective Studies
Risk Factors
Stroke - drug therapy
Thrombolytic Therapy - adverse effects
Thrombolytic Therapy - methods
Tissue Plasminogen Activator - administration & dosage
Tissue Plasminogen Activator - therapeutic use
Urokinase-Type Plasminogen Activator - administration & dosage
Urokinase-Type Plasminogen Activator - therapeutic use
Title Risk of Symptomatic Intracerebral Hemorrhage in Patients Treated with Intra-Arterial Thrombolysis
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