Τίτλος:
Cerebral Microbleeds and Risk of Intracerebral Hemorrhage Post Intravenous Thrombolysis
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Background Stroke patients who have cerebral micro bleeds (CMBs) could be potentially at a greater risk for symptomatic intracerebral hemorrhage (sICH) than those patients without CMBs. The aim of our study was to investigate whether the presence and burden of CMBs are associated with post IVT sICH. Methods In this multicenter study, consecutive patients treated with intravenous tissue plasminogen activator were prospectively identified and analyzed. Patients without magnetic resonance imaging (MRI) within 24 hours of treatment were excluded. CMBs were defined as round or oval, hypointense lesions with associated blooming on T2*-weighted MRI up to 10 mm in diameter. Outcome measures included the occurrence of sICH or death. Results Of 672 patients with IVT (mean age 62 ± 14 years, 52% men, median admission NIHSS: 7 points), 103 patients had CMBs on T2*-MRI. Ten patients had more than 10, whereas the remaining 93 patients had 1-10 CMBs on T2*-MRI. The rates of sICH did not differ between patients with and patients without 1-10 CMBs (5.8% versus 3.5%; P = .27). However, sICH occurred more frequently (P = .0009) in patients with > 10 CMBs (30%, 95% confidence interval [CI] by the adjusted Wald method: 10%-61%). After adjusting for potential confounders, the presence of >10 CMBs on T2*-MRI was independently (P = .0004) associated with a higher likelihood for sICH (odds ratio [OR]:13.4, 95%CI:3.2-55.9). Conclusions Our findings indicate an increased risk of sICH after IVT when more than 10 CMBs are present. © 2017 National Stroke Association
Συγγραφείς:
Zand, R.
Tsivgoulis, G.
Singh, M.
McCormack, M.
Goyal, N.
Ishfaq, M.F.
Shahripour, R.B.
Nearing, K.
Elijovich, L.
Alexandrov, A.W.
Liebeskind, D.S.
Alexandrov, A.V.
Περιοδικό:
Journal of Stroke and Cerebrovascular Diseases
Λέξεις-κλειδιά:
tissue plasminogen activator; fibrinolytic agent; tissue plasminogen activator, adult; aged; Article; brain hemorrhage; cerebrovascular accident; clinical outcome; controlled clinical trial; controlled study; diffusion weighted imaging; evaluation study; female; fibrinolytic therapy; hospital mortality; human; major clinical study; male; middle aged; multicenter study; National Institutes of Health Stroke Scale; neuroimaging; priority journal; prospective study; seizure; stroke patient; subarachnoid hemorrhage; adverse effects; brain hemorrhage; chemically induced; clinical trial; computed tomography scanner; diagnostic imaging; intravenous drug administration; nuclear magnetic resonance imaging; Stroke; very elderly, Administration, Intravenous; Adult; Aged; Aged, 80 and over; Cerebral Hemorrhage; Female; Fibrinolytic Agents; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Prospective Studies; Stroke; Tissue Plasminogen Activator; Tomography Scanners, X-Ray Computed
DOI:
10.1016/j.jstrokecerebrovasdis.2016.11.127
