Symptomatic intracerebral hemorrhage and recanalization after IV rt-PA

A multicenter study

M. Saqqur, Georgios Tsivgoulis, C. A. Molina, A. M. Demchuk, M. Siddiqui, J. Alvarez-Sabín, K. Uchino, S. Calleja, Andrei Alexandrov

Research output: Contribution to journalArticle

72 Citations (Scopus)

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] ĝ‰¥ 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: The risk of tPA-related symptomatic intracerebral hemorrhage (sICH) is low after early and complete restoration of blood flow. Arterial occlusion persistent beyond tissue plasminogen activator infusion emerges as an independent predictor of higher risk of sICH in patients treated with systemic thrombolysis.

Original languageEnglish (US)
Pages (from-to)1304-1312
Number of pages9
JournalNeurology
Volume71
Issue number17
DOIs
StatePublished - Oct 21 2008

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Cerebral Hemorrhage
Tissue Plasminogen Activator
Multicenter Studies
Stroke
Brain Ischemia
Nervous System
Therapeutics
Logistic Models
Regression Analysis
Hemorrhage
Blood Pressure
Glucose

All Science Journal Classification (ASJC) codes

  • Clinical Neurology

Cite this

Symptomatic intracerebral hemorrhage and recanalization after IV rt-PA : A multicenter study. / Saqqur, M.; Tsivgoulis, Georgios; Molina, C. A.; Demchuk, A. M.; Siddiqui, M.; Alvarez-Sabín, J.; Uchino, K.; Calleja, S.; Alexandrov, Andrei.

In: Neurology, Vol. 71, No. 17, 21.10.2008, p. 1304-1312.

Research output: Contribution to journalArticle

Saqqur, M, Tsivgoulis, G, Molina, CA, Demchuk, AM, Siddiqui, M, Alvarez-Sabín, J, Uchino, K, Calleja, S & Alexandrov, A 2008, 'Symptomatic intracerebral hemorrhage and recanalization after IV rt-PA: A multicenter study', Neurology, vol. 71, no. 17, pp. 1304-1312. https://doi.org/10.1212/01.wnl.0000313936.15842.0d
Saqqur, M. ; Tsivgoulis, Georgios ; Molina, C. A. ; Demchuk, A. M. ; Siddiqui, M. ; Alvarez-Sabín, J. ; Uchino, K. ; Calleja, S. ; Alexandrov, Andrei. / Symptomatic intracerebral hemorrhage and recanalization after IV rt-PA : A multicenter study. In: Neurology. 2008 ; Vol. 71, No. 17. pp. 1304-1312.
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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] ĝ‰¥ 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: The risk of tPA-related symptomatic intracerebral hemorrhage (sICH) is low after early and complete restoration of blood flow. Arterial occlusion persistent beyond tissue plasminogen activator infusion emerges as an independent predictor of higher risk of sICH in patients treated with systemic thrombolysis.",
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T2 - A multicenter study

AU - Saqqur, M.

AU - Tsivgoulis, Georgios

AU - Molina, C. A.

AU - Demchuk, A. M.

AU - Siddiqui, M.

AU - Alvarez-Sabín, J.

AU - Uchino, K.

AU - Calleja, S.

AU - Alexandrov, Andrei

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N2 - 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] ĝ‰¥ 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: The risk of tPA-related symptomatic intracerebral hemorrhage (sICH) is low after early and complete restoration of blood flow. Arterial occlusion persistent beyond tissue plasminogen activator infusion emerges as an independent predictor of higher risk of sICH in patients treated with systemic thrombolysis.

AB - 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] ĝ‰¥ 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: The risk of tPA-related symptomatic intracerebral hemorrhage (sICH) is low after early and complete restoration of blood flow. Arterial occlusion persistent beyond tissue plasminogen activator infusion emerges as an independent predictor of higher risk of sICH in patients treated with systemic thrombolysis.

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