Abstract| Volume 35, ISSUE 2, P229, August 2008

Risk for Symptomatic Intracerebral Hemorrhage after Thrombolysis Assessed by Diffusion-Weighted Magnetic Resonance Imaging

Singer OC, Humpich MC, Fiehler J, et al. Ann Neurol 2008;63:52–60
      This study analyzed patients with acute ischemic stroke and evaluated the risk of developing symptomatic intracerebral hemorrhage (sICH) after the administration of thrombolytic treatment. Patients were studied using data obtained retrospectively from a previous multi-center prospective trial. In total, 645 patients with anterior circulation strokes were studied. All patients received intravenous or intra-arterial thrombolysis within 6 h of symptom onset. Patients were divided into three pre-treatment groups based on magnetic resonance diffusion-weighted imaging (DWI) stroke lesion size: 1) small (< 10 mL), 2) moderate (10–100 mL), and 3) large (> 100 mL). Of the 645 patients studied, 44 (6.8%) developed sICH after thrombolysis. There was a significant difference of sICH in the three pre-treatment groups, with rates of 2.8%, 7.8%, and 16.1% in patients with small, moderate, and large DWI stroke lesions, respectively (p < 0.05). In addition, pre-treatment DWI lesion size was an independent risk factor for potential sICH when evaluating multiple factors with logistic regression analysis. The authors concluded that DWI lesion size is an important risk factor for the development of sICH after thrombolysis in acute stroke and that thrombolytics should be used judiciously in patients with large DWI lesions.
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