Severe hemorrhagic transformation after thrombolysis for acute ischemic stroke prevents early neurological improvement
File(s)
Author(s)
Gill, D
Baheerathan, A
Aravind, A
Veltkamp, R
Kar, A
Type
Journal Article
Abstract
Background
Intravenous thrombolysis can improve neurological outcomes after acute ischemic stroke (AIS), but hemorrhagic transformation (HT) of the infarct remains a risk. Current definitions for symptomatic intracerebral hemorrhage (ICH) all entail that there be some degree of associated neurological deterioration. However, early deleterious effects of secondary ICH might also be manifested as reduced neurological improvement. This study aims to investigate whether there are any independent associations between different radiological subtypes of HT and the degree of neurological improvement 24 hours after thrombolysis.
Methods
This study is a retrospective analysis of a single-center database of consecutive thrombolysis cases for AIS. Multivariate regression analysis was undertaken to explore the relationship between different subtypes of HT with changes in National Institutes of Health Stroke Scale (NIHSS) score 24 hours after thrombolysis, after adjusting for potential confounders.
Results
As compared to cases with no HT, occurrence of the parenchymal hematoma 2 (PH2) subtype of secondary ICH was independently associated with reduced improvement or worsening in the NIHSS score, with an average effect size of 7 points (95% confidence interval −10 to −4, P < .001). In the absence of PH2, thrombolysis for AIS was generally associated with an improvement in the neurological status at 24 hours.
Conclusions
The PH2 subtype of HT is associated with reduced neurological improvement or deterioration 24 hours after thrombolysis for AIS.
Intravenous thrombolysis can improve neurological outcomes after acute ischemic stroke (AIS), but hemorrhagic transformation (HT) of the infarct remains a risk. Current definitions for symptomatic intracerebral hemorrhage (ICH) all entail that there be some degree of associated neurological deterioration. However, early deleterious effects of secondary ICH might also be manifested as reduced neurological improvement. This study aims to investigate whether there are any independent associations between different radiological subtypes of HT and the degree of neurological improvement 24 hours after thrombolysis.
Methods
This study is a retrospective analysis of a single-center database of consecutive thrombolysis cases for AIS. Multivariate regression analysis was undertaken to explore the relationship between different subtypes of HT with changes in National Institutes of Health Stroke Scale (NIHSS) score 24 hours after thrombolysis, after adjusting for potential confounders.
Results
As compared to cases with no HT, occurrence of the parenchymal hematoma 2 (PH2) subtype of secondary ICH was independently associated with reduced improvement or worsening in the NIHSS score, with an average effect size of 7 points (95% confidence interval −10 to −4, P < .001). In the absence of PH2, thrombolysis for AIS was generally associated with an improvement in the neurological status at 24 hours.
Conclusions
The PH2 subtype of HT is associated with reduced neurological improvement or deterioration 24 hours after thrombolysis for AIS.
Date Issued
2016-06-16
Date Acceptance
2016-04-27
Citation
Journal of Stroke & Cerebrovascular Diseases, 2016, 25 (9), pp.2232-2236
ISSN
1532-8511
Publisher
WB Saunders
Start Page
2232
End Page
2236
Journal / Book Title
Journal of Stroke & Cerebrovascular Diseases
Volume
25
Issue
9
Copyright Statement
© 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved. This manuscript is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0/
Identifier
http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000384023700030&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
Subjects
Science & Technology
Life Sciences & Biomedicine
Neurosciences
Peripheral Vascular Disease
Neurosciences & Neurology
Cardiovascular System & Cardiology
Intracerebral hemorrhage
hemorrhagic transformation
ischemic stroke
rtPA
thrombolysisstroke
subtype
TISSUE-PLASMINOGEN ACTIVATOR
INTRAVENOUS THROMBOLYSIS
ALTEPLASE
ECASS
Publication Status
Published