Abstract | BACKGROUND: Symptomatic intracerebral hemorrhage (sICH) is the most unfavorable complication after IV thrombolytic treatment. We aimed to determine the relationship between early recanalization and the risk of sICH. METHODS: Patients with acute stroke received IV tissue plasminogen activator (rt-PA) within 3 hours of symptom onset with transcranial Doppler (TCD) monitoring at four academic centers. sICH was defined as parenchymal hemorrhage on CT in relation to neurologic worsening (NIH Stroke Scale [NIHSS] > or = 4) within 72 hours after treatment. Poor outcome was defined as modified Rankin Scale 3-6 at 3 months. Early recanalization was graded with Thrombolysis in Brain Ischemia (TIBI) system. Multiple logistic regression analyses were used to identify predictors of sICH. RESULTS: A total of 349 patients received rt-PA at median 134 +/- 32 minutes (mean age 69 +/- 13 years, 186 men [53%]). Median pretreatment NIHSS score was 16 points (interquartile range: 12-20). Median time to TCD was 130 +/- 40 minutes. At the end of rt-PA infusion, 135 patients (38%) had no recanalization, 101 (29%) partial, and 113 (32%) complete recanalization. sICH occurred in 26 patients (7.4%). Of the 135 patients without early recanalization, 18 (13%) had sICH, as compared to 4 (4%) of the 109 subjects with partial recanalization and 4 (3.5%) of 113 with complete recanalization, p = 0.005. After adjustment for age, sex, baseline NIHSS score, glucose, blood pressure, and time to treatment, patients with persistent occlusion had sixfold higher risk of sICH (OR = 6, 95% CI 1.5-21.3, p = 0.01). CONCLUSION:
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Authors | M Saqqur, G Tsivgoulis, C A Molina, A M Demchuk, M Siddiqui, J Alvarez-Sabín, K Uchino, S Calleja, A V Alexandrov, CLOTBUST Investigators |
Journal | Neurology
(Neurology)
Vol. 71
Issue 17
Pg. 1304-12
(Oct 21 2008)
ISSN: 1526-632X [Electronic] United States |
PMID | 18753474
(Publication Type: Comparative Study, Journal Article, Multicenter Study, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
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Chemical References |
- Tissue Plasminogen Activator
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Topics |
- Adult
- Aged
- Aged, 80 and over
- Cerebral Hemorrhage
(chemically induced, physiopathology, prevention & control)
- Female
- Humans
- Infusions, Intravenous
- Male
- Middle Aged
- Prospective Studies
- Reperfusion
(methods)
- Retrospective Studies
- Time Factors
- Tissue Plasminogen Activator
(administration & dosage, adverse effects)
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