Time to recanalization and risk of symptomatic intracerebral haemorrhage in patients treated with intravenous thrombolysis

L. Dorado, M. Millán, N. Pérez de la Ossa, C. Guerrero, M. Gomis, A. Aleu, E. López-Cancio, P. Cuadras, A. Dávalos

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Abstract

Background and purpose: To test whether time to recanalization is associated with a progressive risk of symptomatic intracerebral haemorrhage (SICH) after intravenous alteplase (IVT), we conducted a serial transcranial duplex monitoring study up to 24 h after IVT in a cohort of 140 patients with acute ischaemic stroke attributed to large artery occlusion in the anterior circulation. Methods: Patients were classified in four groups according to the time to complete recanalization (Thrombolysis in Brain Ischaemia, TIBI grades 4 or 5) after alteplase bolus: <2 h (n = 53), 2-6 h (n = 9), 6-24 h (n = 32) and no recanalization (NR) at 24 h (n = 46). SICH was defined as any haemorrhagic transformation with National Institute of Health Stroke Scale (NIHSS) score worsening ≥4 points (European Australian Acute Stroke Study II, ECASS II criteria) or parenchymal haematoma type 2 with neurological worsening (SITS-MOST criteria) in the 24-36 h CT. Favourable outcome was defined as modified Rankin score ≤2 at 3 months. Results: There were no differences between the groups of patients who recanalized at each time frame regarding localization of the occlusion ( P = 0.29), stroke severity at baseline ( P = 0.22) and age ( P = 0.06). SICH (ECASS/SITS-MOST) was observed in 5.7%/5.7% of the patients who recanalized in <2 h, in 0%/0% of the patients who recanalized between 2-6 h, in 3.1%/3.1% of the patients who recanalized within 6-24 h and in 2.2%/0% of those patients who did not recanalize at 24 h. The rate of favourable outcome according to the time of recanalization was 79.2%, 50%, 46.9% and 34.1% (P < 0.001). Conclusions: Our findings are in line with the literature showing a relationship between time to recanalization and functional outcome after IVT in acute stroke, but they do not confirm a progressive increase in the rate of SICH. © 2012 The Author(s) European Journal of Neurology © 2012 EFNS.
Original languageEnglish
Pages (from-to)1251-1255
JournalEuropean Journal of Neurology
Volume19
Issue number9
DOIs
Publication statusPublished - 1 Sep 2012

Keywords

  • Acute ischaemic stroke
  • Recanalization
  • Symptomatic intracranial haemorrhage
  • Thrombolytic therapy

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